Less vomit, fewer hospital stays

UNC CHAPEL HILL (US) — An expensive anti-vomiting drug could reduce pediatric hospitalizations and actually save millions of dollars a year, according to a new economic analysis.

Two years ago researchers found that the drug called ondansetron helps reduce vomiting, the need for intravenous fluids, and hospital admissions in children with acute gastroenteritis.

“In the past, people always thought that ondansetron was so expensive that its use wasn’t worth it,” says Michael Steiner, assistant professor of pediatrics at University of North Carolina at Chapel Hill.

“Our findings challenge that belief and may change clinician decision-making as well as practice guidelines.”

The new study was published online this week by the journal PLoS Medicine.

“This study is the first to demonstrate that in addition to being clinically beneficial, the administration of oral ondansetron to children with dehydration and persistent vomiting secondary to gastroenteritis, is economically advantageous, making it a dominant treatment strategy,” says Stephen Freedman, assistant professor of pediatrics at the University of Toronto and the study’s lead author.

Gastroenteritis is an infection, often caused by a virus, that causes vomiting and diarrhea. It is popularly called “stomach flu” and is a very common ailment in children during the winter months. Persistent vomiting from acute gastroenteritis can be very frightening to children and their families and also poses a risk of dehydration.

In many cases gastroenteritis in children can be managed effectively with oral fluids, including oral rehydration therapy, but some cases are severe enough to require hospital admission for intravenous fluids.

However, current practice guidelines do not recommend the use of ondansetron, in part because there was a lack of clear evidence that the treatment is cost effective.

To answer this question, study authors used a type of statistical analysis, called decision tree analysis, to compare the costs of treatment in the hospital emergency department setting both with and without ondansetron.

Due to significant price differences between the U.S. and Canada, separate analysis for each country were conducted.

They concluded that giving ondansetron to eligible children in the U.S. would prevent 29,246 intravenous insertions and 7,220 hospitalizations each year, with annual savings of $65.6 million to society and $61.1 million to payers of health care costs (including private insurance providers and Medicare and Medicaid).

In Canada, the study concluded, ondansetron given routinely would prevent 4,065 intravenous insertions and 1,003 hospitalizations each year, with annual savings of $1.72 million (in Canadian dollars) to society and $1.18 million to payers of health care costs.

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