Cost-utility of use of sputum eosinophil counts to guide management in children with asthma.

BACKGROUND: Tailoring asthma interventions based on sputum eosinophils are beneficial in reducing the frequency of asthma exacerbations. The routine use of sputum eosinophils in asthma in children is not uniformly adopted. The main barriers to policymakers adopting new technologies are always doubts about their cost-utility in scenarios with scarce health resources. This study aimed to evaluate the cost-utility of sputum eosinophil counts to guide management in children with asthma, from a societal perspective. METHODS: A Markov simulation with three mutually exclusive nonabsorbent states was used. The intervention evaluated was adjustment of asthma therapy based on sputum eosinophils to adjusting therapy based on clinical symptoms with or without spirometry/peak flow in children between 4 and 18 years of age (EO). The group comparison was adjusting therapy based on clinical symptoms with or without spirometry/peak flow (SC). The analysis was carried out from a societal perspective. The analytic horizon was 12 months. RESULTS: The model showed that EO was associated with lower cost than SC (US $1375 vs US $1454 average annual cost per patient), and higher QALYs (0.95 vs 0.92 average per patient); showing dominance. The probability that EO provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness to pay thresholds. CONCLUSION: EO was cost-effective for infants with asthma to guide asthma management in Children. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

Cost-utility of as-needed combination low-dose budesonide-formoterol in adolescents mild asthma.

BACKGROUND: Previously evidence has demonstrated that as-needed combination low-dose budesonide-formoterol reduced the risk of severe exacerbations compared with short-acting ß2-agonist (SABA) reliever therapy in an adolescent with mild asthma. Concerns as if the extra benefit offered by this drug outweighs the additional cost. This study aimed to evaluate the cost-effectiveness of as-needed combination low-dose budesonide-formoterol compared with short-acting ß2-agonist (SABA) reliever therapy in adolescents with mild asthma in Colombia. METHODS: A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with mild asthma in Colombia. Total costs and QALYs of low-dose budesonide-formoterol compared with short-acting ß2-agonist (SABA) were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. RESULTS: The model suggests a potential gain of 0.03 QALYs and per patient per year on low-dose budesonide-formoterol. The cost difference per person was US$-4 per patient per year in favor of budesonide- formoterol. The position of dominance negates the need to calculate an incremental cost-effectiveness ratio. In the one-way and probabilistic sensitivity analyses, our base-case results were robust to variations of all assumptions and parameters. CONCLUSION: In conclusion, low-dose budesonide-formoterol as a reliever was found to be cost-effective when added to usual care in adolescents with mild asthma. This evidence should promote economic evaluations in developed and developing countries for the inclusion of new drugs in health insurance plans.

Broncoscopía flexible en niños con atelectasias persistentes: Serie de casos / Flexible Fiberoptic Bronchoscopy in children with persistent atelectasis: A case series report

La mayoría de los niños con atelectasias pulmonares presentan una resolución completa con el tratamiento médico. En atelectasias persistentes, el tratamiento broncoscópico sería una alternativa terapéutica efectiva para lograr la resolución de esta patología. Objetivo. Describir nuestra experiencia al utilizar la broncoscopía flexible en niños con diagnóstico de atelectasia persistente. Resultados. Un total de 106 broncoscopías fueron realizadas por la Sección de Neumonología Pediátrica del Hospital Italiano entre enero de 2005 y diciembre de 2013, de las cuales 32 correspondieron a pacientes con atelectasia persistente. La mediana de edad fue de 5 años. La vía de abordaje más utilizada fue la máscara laríngea. En 28/32 pacientes, se logró una reexpansión completa o parcial. Los procedimientos fueron bien tolerados. Conclusiones. La broncoscopía flexible resultó ser una herramienta segura y de gran valor terapéutico para el tratamiento de esta serie de niños con atelectasias persistentes.(AU)

Most patients with pulmonary atelectasis have complete resolution with medical therapy. In patients with persistent atelectasis, endoscopic treatment has proven to be an effective therapy. Objective. To describe our experience using flexible fiberoptic bronchoscopy in children with persistent atelectasis. This is a case series report of children treated with flexible bronchoscopy between January 2005 and December 2013, at the Pediatric Pulmonology Section of the Hospital Italiano de Buenos Aires. Results. From a total of 106 bronchoscopies performed, 32 of the patients had a diagnosis of persistent atelectasis. Mean age, 5 years. Laryngeal mask airway was the most common route for flexible bronchoscopy. In 28/32 patients, the procedure was therapeutically useful (complete or partial re-expansion). The procedure was well tolerated and presented only mild complications. Conclusions. Flexible bronchoscopy proved to be a safe and effective tool for the treatment of children with persistent atelectasis.(AU)

Broncoscopía flexible en niños con atelectasias persistentes: Serie de casos / Flexible Fiberoptic Bronchoscopy in children with persistent atelectasis: A case series report

La mayoría de los niños con atelectasias pulmonares presentan una resolución completa con el tratamiento médico. En atelectasias persistentes, el tratamiento broncoscópico sería una alternativa terapéutica efectiva para lograr la resolución de esta patología. Objetivo. Describir nuestra experiencia al utilizar la broncoscopía flexible en niños con diagnóstico de atelectasia persistente. Resultados. Un total de 106 broncoscopías fueron realizadas por la Sección de Neumonología Pediátrica del Hospital Italiano entre enero de 2005 y diciembre de 2013, de las cuales 32 correspondieron a pacientes con atelectasia persistente. La mediana de edad fue de 5 años. La vía de abordaje más utilizada fue la máscara laríngea. En 28/32 pacientes, se logró una reexpansión completa o parcial. Los procedimientos fueron bien tolerados. Conclusiones. La broncoscopía flexible resultó ser una herramienta segura y de gran valor terapéutico para el tratamiento de esta serie de niños con atelectasias persistentes.

Most patients with pulmonary atelectasis have complete resolution with medical therapy. In patients with persistent atelectasis, endoscopic treatment has proven to be an effective therapy. Objective. To describe our experience using flexible fiberoptic bronchoscopy in children with persistent atelectasis. This is a case series report of children treated with flexible bronchoscopy between January 2005 and December 2013, at the Pediatric Pulmonology Section of the Hospital Italiano de Buenos Aires. Results. From a total of 106 bronchoscopies performed, 32 of the patients had a diagnosis of persistent atelectasis. Mean age, 5 years. Laryngeal mask airway was the most common route for flexible bronchoscopy. In 28/32 patients, the procedure was therapeutically useful (complete or partial re-expansion). The procedure was well tolerated and presented only mild complications. Conclusions. Flexible bronchoscopy proved to be a safe and effective tool for the treatment of children with persistent atelectasis.

[Flexible Fiberoptic Bronchoscopy in children with persistent atelectasis: a case series report]. / Broncoscopía flexible en niños con atelectasias persistentes. Serie de casos.

UNLABELLED: Most patients with pulmonary atelectasis have complete resolution with medical therapy. In patients with persistent atelectasis, endoscopic treatment has proven to be an effective therapy. OBJECTIVE: To describe our experience using flexible fiberoptic bronchoscopy in children with persistent atelectasis. This is a case series report of children treated with flexible bronchoscopy between January 2005 and December 2013, at the Pediatric Pulmonology Section of the Hospital Italiano de Buenos Aires. RESULTS: From a total of 106 bronchoscopies performed, 32 of the patients had a diagnosis of persistent atelectasis. Mean age, 5 years. Laryngeal mask airway was the most common route for flexible bronchoscopy. In 28/32 patients, the procedure was therapeutically useful (complete or partial re-expansion). The procedure was well tolerated and presented only mild complications. CONCLUSIONS: Flexible bronchoscopy proved to be a safe and effective tool for the treatment of children with persistent atelectasis.

Broncoscopía flexible en niños con atelectasias persistentes: Serie de casos. / [Flexible Fiberoptic Bronchoscopy in children with persistent atelectasis: A case series report].

Most patients with pulmonary atelectasis have complete resolution with medical therapy. In patients with persistent atelectasis, endoscopic treatment has proven to be an effective therapy. Objective. To describe our experience using flexible fiberoptic bronchoscopy in children with persistent atelectasis. This is a case series report of children treated with flexible bronchoscopy between January 2005 and December 2013, at the Pediatric Pulmonology Section of the Hospital Italiano de Buenos Aires. Results. From a total of 106 bronchoscopies performed, 32 of the patients had a diagnosis of persistent atelectasis. Mean age, 5 years. Laryngeal mask airway was the most common route for flexible bronchoscopy. In 28/32 patients, the procedure was therapeutically useful (complete or partial re-expansion). The procedure was well tolerated and presented only mild complications. Conclusions. Flexible bronchoscopy proved to be a safe and effective tool for the treatment of children with persistent atelectasis.