J Pediatr. 2014 Jul 1. pii: S0022-3476(14)00458-2. doi: 10.1016/j.jpeds.2014.05.031. [Epub ahead of print]

Costs of Bronchoalveolar Lavage-Directed Therapy in the First 5 Years of Life for Children with Cystic Fibrosis.

Moodie M1, Lal A2, Vidmar S3, Armstrong DS4, Byrnes CA5, Carlin JB3, Cheney J6, Cooper PJ7, Grimwood K6, Robertson CF8, Tiddens HA9, Wainwright CE6;Australasian Cystic Fibrosis Bronchoalveolar Lavage Study Investigators.

Author information

• 1Deakin Health Economics, Faculty of Health, Deakin University, Burwood, Australia. Electronic address: marj.moodie@deakin.edu.au.
• 2Deakin Health Economics, Faculty of Health, Deakin University, Burwood, Australia.
• 3Murdoch Children's Research Institute and Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
• 4Monash Medical Centre, Melbourne, Australia.
• 5Starship Children's Hospital, Auckland, New Zealand.
• 6Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Brisbane, Australia.
• 7The Children's Hospital at Westmead, Sydney, Australia.
• 8Royal Children's Hospital, Melbourne, Australia.
• 9Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.

Abstract

OBJECTIVES:

To determine whether bronchoalveolar lavage (BAL)-directed therapy for infants and young children with cystic fibrosis (CF), rather than standard therapy, was justified on the grounds of a decrease in average costs and whether the use of BAL reduced treatment costs associated with hospital admissions.

STUDY DESIGN:

Costs were assessed in a randomized controlled trial conducted in Australia and New Zealand on infants diagnosed with CF after newborn screening and assigned to receive either BAL-directed or standard therapy until they reached 5 years of age. A health care funder perspective was adopted. Resource use measurement was based on standardized data collection forms administered for patients across all sites. Unit costs were obtained primarily from government schedules.

RESULTS:

Mean costs per child during the study period were Australian dollars (AUD)92 860 in BAL-directed therapy group and AUD90 958 in standard therapy group (mean difference AUD1902, 95% CI AUD-27 782 to 31 586, P = .90). Mean hospital costs per child during the study period were AUD57 302 in the BAL-directed therapy group and AUD66 590 in the standard therapy group (mean difference AUD-9288; 95% CI AUD-35 252 to 16 676, P = .48).

CONCLUSIONS:

BAL-directed therapy did not result in either lower mean hospital admission costs or mean costs overall compared with managing patients with CF by a standard protocol based upon clinical features and oropharyngeal culture results alone. Following on our previous findings that BAL-directed treatment offers no clinical advantage over standard therapy at age 5 years, flexible bronchoscopy with BAL cannot be recommended for the routine management of preschool children with CF on the basis of overall cost savings.