Cost-effectiveness analysis of oral rehydration therapy compared to intravenous rehydration for acute gastroenteritis without severe dehydration treatment

Introduction: In high-income countries, vomiting often impedes oral rehydration therapy, leading to intravenous rehydration fluid administration to children with acute gastroenteritis. Ondansetron administration reduces vomiting and intravenous fluid administration in this population. We evaluated whether ondansetron is similarly effective when employed in Pakistan. Methods: In this 2-hospital, double-blind, placebo-controlled, emergency department-based, randomized trial, we recruited children aged 0·5 to 5·0 years, without dehydration, who had diarrhea and 1 episode of vomiting within 4 hours of arrival. Patients were randomly assigned (1:1), via an internet-based randomization service, using a stratified, variable block randomization scheme, to receive a single dose of oral ondansetron or placebo. The primary endpoint was intravenous rehydration (administration of 20 ml/kg over 4 hours of an isotonic fluid) within 72 hours of randomization. All randomized children were analysed. Results: From July 3, 2014, to January 12, 2017, 626 children were randomized. Intravenous rehydration was provided to 10.8% (34/314) and 10.3% (27/312) of children administered placebo and ondansetron, respectively (OR: 0.946; 95% CI: 0.564, 1.587; P=0.834). A regression model fitted with treatment group and adjusted for antiemetic administration and vomiting frequency in the preceding 24 hours, yielded similar results; OR=0.952; 95% CI: 0.570, 1.589; P=0.850. There was no evidence of interaction between treatment group and age (P=0.974), 3 diarrheal stools in the preceding 24 hours (P=0.983) or 3 vomits in the preceding 24 hours (P=0.554). During the 4-hour study observation period, 24.0% (75/314) and 19.6% (61/312) of children in the placebo and ondansetron groups vomited, respectively; OR: 0.774; 95%CI: 0.528, 1.133; P=0.187. Conclusion: Ondansetron administration did not significantly reduce intravenous rehydration use, suggesting that in children without dehydration, ondansetron administration does not significantly alter the disease course and should not be administered to this group of children.

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118 Predictors of intravenous rehydration in children with acute gastroenteritis in the United States and Canada

Paediatrics & Child Health ◽

10.1093/pch/pxz066.117 ◽

2019 ◽

Vol 24 (Supplement_2) ◽

pp. e45-e45

Author(s):

Naveen Poonai ◽

Elizabeth C Powell ◽

David Schnadower ◽

Charlie Casper ◽

Cindy Roskind ◽

...

Keyword(s):

Knowledge Translation ◽

Acute Gastroenteritis ◽

Secondary Analysis ◽

Oral Rehydration Therapy ◽

The United States ◽

Pediatric Emergency ◽

Research Network ◽

Oral Rehydration ◽

Intravenous Rehydration ◽

Knowledge Translation Strategies

Abstract Background Although oral rehydration therapy is recommended for children with acute gastroenteritis (AGE) with none to some dehydration, intravenous (IV) rehydration is still commonly administered to these children in high-income countries. IV rehydration is associated with pain, anxiety, and emergency department (ED) revisits in children with AGE. Objectives We sought to better understand the factors associated with IV rehydration in children with AGE in order to inform knowledge translation strategies. Design/Methods This was a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) randomized, controlled trials of oral probiotics in children with AGE-associated diarrhea. Eligible children were aged 3–48 months and reported >3 watery stools in a 24-hour period. The primary outcome was administration of IV rehydration at the index ED visit. We used mixed-effects logistic regression model to explore univariable and multivariable relationships between IV rehydration and a prioririsk factors. Results From the parent study sample of 1848 participants, 1846 had data available for analysis: mean (SD) age of 19.1 ± 11.4 months, 45.4% females. 70.2% (1292/1840) vomited within 24 hours of the index ED visit and 34.1% (629/1846) received ondansetron in the ED. 13.0% (240/1846) were administered IV rehydration at the index ED visit, and 3.6% (67/1842) were hospitalized. Multivariable predictors of IV rehydration were Clinical Dehydration Scale (CDS) score [compared to none: mild to moderate (OR: 8.1, CI: 5.5–11.8); severe (OR: 45.9, 95% CI: 20.1–104.7), P<0.001], ondansetron in the ED (OR: 1.8, CI: 1.2–2.6, P=0.003), previous healthcare visit for the same illness [compared to no prior visit: prior visit with no IV (OR: 1.9, 95% CI: 1.3–2.9); prior visit with IV (OR: 10.5, 95% CI: 3.2–34.8), P<0.001], and country [compared to Canada: US (OR: 4.1, CI: 2.3–7.4, P<0.001]. Significantly more participants returned to the ED with symptoms of AGE within 3 days if IV fluids were administered at the index visit [30/224 (13.4%) versus 88/1453 (6.1%), P<0.001]. Conclusion Higher CDS scores, antiemetic use, previous healthcare visits and country were independent predictors of IV rehydration which was also associated with increased ED revisits. Knowledge translation focused on optimizing the use of antiemetics (i.e. for those with dehydration) and reducing the geographic variation in IV rehydration use may improve the ED experience and reduce ED-revisits.

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‘“These Findings Confirm Conclusions Many Have Arrived at by Intuition or Common Sense”: Water, Quantification and Cost-effectiveness at the World Bank, ca. 1960 to 1995’

Social History of Medicine ◽

10.1093/shm/hkaa006 ◽

2020 ◽

Author(s):

Christian McMillen

Keyword(s):

Cost Effectiveness ◽

Global Health ◽

Common Sense ◽

Large Scale ◽

Good Health ◽

Cost Effectiveness Analysis ◽

Clean Water ◽

Water And Sanitation ◽

Oral Rehydration ◽

Effectiveness Analysis

Abstract Providing clean water and sanitation was based on the common-sense notion that each had obvious benefits. Overcoming uncertainty, achieving precision, and quantifying the effects of clean water and sanitation came to dominate thinking on water and sanitation in the 1980s. As cost effectiveness analysis infiltrated global health the broad goal of providing clean water and adequate sanitation diminished in importance as short term solutions like Oral Rehydration Therapy prevailed. Seeking cost-effective solutions to large scale problems in global health while also wanting to quantify their benefits has common-sense appeal. But when it comes to water and sanitation cost effectiveness analysis has confronted at least one insurmountable challenge: quantifying the benefits of water and sanitation is, and has always, been notoriously difficult. It is intuitive that clean water and adequate sanitation contribute to good health. Quantifying the effects, as we will see, are all but impossible.

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Cost-effectiveness of oral ondansetron for children with acute gastroenteritis in primary care: a randomised controlled trial

British Journal of General Practice ◽

10.3399/bjgp.2020.1093 ◽

2021 ◽

pp. BJGP.2020.1093

Author(s):

Anouk AH Weghorst ◽

Gea A Holtman ◽

Irma J Bonvanie ◽

Pien I Wolters ◽

Boudewijn J Kollen ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Acute Gastroenteritis ◽

Controlled Trial ◽

Oral Rehydration Therapy ◽

Out Of Hours ◽

Oral Rehydration ◽

Randomised Controlled ◽

Oral Ondansetron

Background: Acute gastroenteritis is a common childhood disease with substantial medical and indirect costs, mostly because of referral, hospitalization and parental absence from work. Aim: To determine the cost-effectiveness of adding oral ondansetron to care-as-usual for children with acute gastroenteritis in out-of-hours primary care. Design and setting: A pragmatic randomised controlled trial at three out-of-hours primary care centres, with a follow-up of 7 days. Method: Inclusion criteria were: 1) age 6 months to 6 years; 2) diagnosis of acute gastroenteritis; 3) at least four reported episodes of vomiting 24 hours before presentation, whereof; 4) at least one in the 4 hours before presentation; and 5) written informed consent from both parents. Children were randomly allocated in a 1:1 ratio to either care-as-usual (oral rehydration therapy) or care-as-usual plus one dose of 0.1 mg/kg oral ondansetron. Results: In total, 194 children were included for randomisation. One dose of oral ondansetron decreased the proportion of children who continued vomiting within the first 4 hours from 42.9% to 19.5%, with an odds ratio of 0.4 (95% CI = 0.2–0.7, NNT 4). Total mean costs in the ondansetron group were 31.2% lower (€488 vs €709), and the total incremental mean costs for an additional child free of vomiting in the first 4 hours was −€9 (95% confidence interval, −€41 to €3). Conclusion: A single oral dose of ondansetron for children with acute gastroenteritis, given in out-of-hours primary care settings, is both clinically beneficial and cost-effective.

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