Cost-effectiveness of treating infantile haemangioma with propranolol in an outpatient setting

Chaturvedi, Kanupriya; Steinberg, J.S.; Snyder, Christopher S.

doi:10.1017/s1047951118000987

Cited by 10 publications

(6 citation statements)

References 19 publications

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“…Most patients (81%) underwent a conventional initiation protocol with a 3-week titration phase in day care hospital. This protocol seems safe and adapted to most children with IH, as reported in cost-effectiveness studies 48 . Nevertheless, a 3-week delay to reach the maintenance dose of 3 mg/kg/day may not be appropriate in a therapeutic emergency situation, such as in IH involving any vital risk, uncontrolled bleeding, ulceration, pain or infectious risk.…”

Section: Discussionmentioning

confidence: 90%

Hemangiol® in infantile haemangioma: A paediatric post-marketing surveillance drug study

et al.

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Aim: Infantile haemangioma (IH) is the most common benign tumour in children. Since 2014, propranolol has become the first-choice therapy and currently Hemangiol® is the only approved drug for complicated haemangioma. This post-marketing study reported the use of Hemangiol® for IH in paediatric practice. Method and Results: From January 2014 to November 2018, 94 children (median age 4 [0;21] months; 75% female) treated with Hemangiol® for proliferative IH were enrolled in the study. The systematic paediatric cardiology consultation never contraindicated beta-blockers. Two Hemangiol® initiation protocols were used: a conventional ambulatory 3-week titration phase protocol (N=76, 80.9%), and a rapid initiation protocol with a 48-hour dose escalation in conventional hospitalization for severe proliferative IH (N=18, 19.1%). In both protocols, the haemodynamic tolerance was good. The mean maintenance dose of Hemangiol® was 2.7±0.8 mg/kg/day, with a median treatment duration of 7 [1.5;19] months. Adverse events (AEs) have been found in 25 (26,6%) patients including 8 (8.5%) patients with serious AEs (uncontrolled bronchial hyperreactivity, N=5; serious hypoglycaemia, N=3). Some patients had one or more AEs, a total of 24 non-serious AEs was reported in 19 patients (sleep disturbances, N=9; respiratory disorders, N=5; digestive disorders, N=6). No cardiac adverse event was reported. Conclusion: This post-marketing surveillance drug study supports the good tolerance of Hemangiol® in children with IH. A rapid initiation protocol is of interest when treatment is urgent. The pre-therapeutic paediatric cardiology consultation should not be systematic but only indicated on specific patients.

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Section: Discussionmentioning

confidence: 90%

Hemangiol® in infantile haemangioma: A paediatric post-marketing surveillance drug study

et al.

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“…With so few patients experiencing propranolol-related complications, there is potential in reducing the rate of these admissions to decrease overall cost of treatment for IHs. Outpatient cost for IH treatment with propranolol was $138, which increased to $828 after the addition of an echocardiogram compared to $2603 for a single hospital day and increased to $2843 with the addition of an echocardiogram [18]. It is clear that there is a strong case for outpatient management for IH treated with propranolol, when appropriate.…”

Section: Discussionmentioning

confidence: 99%

Infantile Hemangioma Treated with Propranolol Readmission Trends, Complications of Therapy, and Cost: A PHIS Database Study

Hairston

Zaniletti

Kompelli

et al. 2022

International Journal of Pediatrics

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Objective. To examine admission trends, complications, and costs for inpatient infantile hemangioma (IH) associated with propranolol therapy utilizing the Pediatric Health Information System (PHIS) database. Study Design. A retrospective cohort study was completed using the PHIS database. The PHIS database was queried from 2008 to 2020 for children without cardiac disease and between the ages of three weeks and one year who were admitted with a diagnosis of IH and administered propranolol. Admissions were trended annually and by geographic region. Primary outcomes were length of stay (LOS), readmission, mortality, propranolol-related complications, and costs. Bivariate and multivariable analyses were employed to identify predictors of the primary outcomes. Results. A total of 2290 unique patient encounters were identified. Admissions steadily decreased after 2011, with variations by geographic region. There was no mortality and only 60 (2.6%) propranolol-related complications. African-American race (odds ratio (OR) 1.20 [95% CI: 1.02-1.41]), respiratory comorbidities (OR 2.04 [95% CI: 1.42-2.93]), neurologic conditions (OR 1.34 [95% CI: 1.09-1.59]), admission to an intensive care unit (OR 1.31 [95% CI: 1.09-1.59]), bronchospasm (OR 1.37 [95% CI: 1.22-1.55]), and hyperkalemia (OR 1.86 [95% CI: 1.08-3.20]) were associated with increased LOS. Neurologic conditions (OR 2.87 [95% CI: 1.76-4.67]) and respiratory comorbidities (OR 2.48 [CI: 1.43-4.30]) were associated with readmission. Average cost per admission was $5,158 ($3,259 to $8,560 range). Conclusion. There is an overall national decline in rate of admissions for IH propranolol therapy. Inpatient admission may be beneficial for patients with neurologic or respiratory conditions.

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“…Although propranolol is the treatment of choice for both proliferating and ulcerated IH, pulsed dye lasers still play a major role in residual IH [ 42 ]. Moreover, treating IH with propranolol was more cost-effective when delivered in outpatient settings [ 43 ]. Monitoring of vital signs is not necessary in normal conditions [ 44 ], and routine cardiac screening using electrocardiogram and echocardiogram prior to outpatient visits is not definitely indicated [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Systemic and Topical Beta-Blockers in Dermatology: A Systematic Review

Alhazmi

Basendwh

Aman

et al. 2022

Dermatol Ther (Heidelb)

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Introduction: Beta-blockers are proven to be safe and cost-effective agents in treating multiple dermatological conditions, which is why they are considered as an interesting and good alternative therapeutic agent by dermatologists. To our knowledge, there has been no comprehensive systematic review to date summarizing the role of both systemic and topical betablockers in dermatology. Methods: In this systematic review, we aim to review recent and relevant published literature in order to provide a comprehensive evidencebased summary to inform dermatologists. Results: An electronic-based literature search was carried out during October-December 2021 in the databases PubMed (MEDLINE), SCOPUS (EMBASE), and Cochrane Library. Furthermore, bibliographic sources were also reviewed for the selected articles. We followed The Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA) guidelines. We reviewed published literature about the role of beta-blockers in dermatology for the time period (January 2016 to December 2021). Conclusions: A total of 126 publications were retrieved from different databases, of which 59 studies were finally included in our review after excluding non-eligible literature in accordance with our inclusion and exclusion criteria. The included articles consisted of meta-analyses, systematic reviews, clinical trials, retrospective and prospective cohort studies, case-control studies, case series, and case reports. In general, data in reviewed literature showed that both systemic and topical beta-blockers were reliable and safe therapeutic options in treating different dermatoses. Their effect has been studied as a mono-therapy, also as an adjuvant therapy combined with other current disease-specific therapeutic modalities such as lasers, radiation, chemotherapy, corticosteroids, or other betablockers options. Local and systemic adverse effects were mainly minor and non-significant.

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Cost-effectiveness of treating infantile haemangioma with propranolol in an outpatient setting

Abstract: Treating infantile haemangioma with propranolol is more cost-effective when initiated on an outpatient basis.

Cited by 10 publications

References 19 publications

Hemangiol® in infantile haemangioma: A paediatric post-marketing surveillance drug study

Hemangiol® in infantile haemangioma: A paediatric post-marketing surveillance drug study

Infantile Hemangioma Treated with Propranolol Readmission Trends, Complications of Therapy, and Cost: A PHIS Database Study

The Role of Systemic and Topical Beta-Blockers in Dermatology: A Systematic Review

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