Oral Ondansetron Administration in Emergency Departments to Children with Gastroenteritis An Economic Analysis 英文参考文献.docVIP

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Oral Ondansetron Administration in Emergency Departments to Children with Gastroenteritis An Economic Analysis 英文参考文献.doc

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Oral Ondansetron Administration in Emergency Departments to Children with Gastroenteritis An Economic Analysis 英文参考文献

OralOndansetronAdministrationinEmergency DepartmentstoChildrenwithGastroenteritis:An EconomicAnalysis StephenB.Freedman1,2,3*,MichaelJ.Steiner4,KevinJ.Chan1,3,5 1Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada, 2Division of Gastroenterology, Hepatology and Nutrition, The HospitalforSickChildren,Toronto,Ontario,Canada,3TheUniversityofToronto,Toronto,Ontario,Canada,4DepartmentofPediatrics,TheUniversityofNorthCarolina SchoolofMedicine,ChapelHill,NorthCarolina,UnitedStatesofAmerica,5MunkCentreforGlobalStudies,Toronto,Ontario,Canada Abstract Background:Theuseofantiemeticsforchildrenwithvomitingisoneofthemostcontroversialdecisionsinthetreatmentof gastroenteritis in developed countries. Ondansetron, a selective serotonin receptor antagonist, has been found to be effective in improving the success of oral rehydration therapy. However, North American and European clinical practice guidelines continue to recommend against its use, stating that evidence of cost savings would be required to support ondansetronadministration.Thus,aneconomicanalysisoftheemergencydepartmentadministrationofondansetronwas conducted.Theprimaryobjectivewastoconductacostanalysisoftheroutineadministrationofondansetroninboththe UnitedStatesandCanada. Methods and Findings: A cost analysis evaluated oral ondansetron administration to children presenting to emergency departments with vomiting and dehydration secondary to gastroenteritis from a societal and health care payer’s perspective in both the US and Canada. A decision tree was developed that incorporated the frequency of vomiting, intravenousinsertion,hospitalization,andemergencydepartmentrevisits.Estimatesofthemonetarycostsassociatedwith ondansetronuse,intravenousrehydration,andhospitalizationwerederivedfromadministrativedatabasesoremergency departmentuse.Theeconomicburdeninchildrenadministeredondansetronplusoralrehydrationtherapywascompared tothosenotadministeredondansetronemployingdeterministica