This retrospective cohort study examines the risk of adverse pregnancy outcomes in women with gestational diabetes treated with glyburide vs insulin.
This review finds that understanding of the pathophysiological features of hypoxic-ischemic encephalopathy is improving. Treatment with hypothermia has become the foundation of therapy.
This retrospective cohort study suggests that clinicians reconsider the practice of treating otherwise healthy children with acute osteomyelitis with prolonged intravenous antibiotics when an equally effective oral alternative exists.
Halfon and Kuo review the history and rationale for the proposed changes for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and consider how the proposed changes are likely to create new challenges for parents attempting to organize their children’s care and for pediatricians providing that care and assisting with care coordination.
To evaluate the cost-effectiveness of immunoprophylaxis against respiratory syncytial virus (RSV) infections with palivizumab based on actual cost and observed incidence rates in various pediatric risk groups.
Decision tree analysis comparing children with various combinations of the following indications: chronic lung disease, congenital heart disease, or prematurity (≤32 weeks gestation), and children with none of these indications. One-way sensitivity analyses and Monte Carlo simulations were used to quantify parameter uncertainty.
Florida during the 2004-2005 RSV season.
A total of 159 790 Medicaid-eligible children aged 0 to 2 years.
Palivizumab prophylaxis compared with no prophylaxis.
Incremental cost (2010 US dollars) per hospitalization for RSV infection avoided.
The mean cost of palivizumab per dose ranged from $1661 for infants younger than 6 months of age to $2584 for children in their second year of life. Among preterm infants younger than 6 months of age without other indications, immunoprophylaxis with palivizumab cost $302 103 (95% confidence interval, $141 850-$914 798) to prevent 1 RSV-related hospitalization. Given a mean cost of $8910 for 1 RSV-related hospitalization in this subgroup, palivizumab would be cost-neutral at a per-dose cost of $47. Incremental cost-effectiveness ratios for the other subgroups ranged from $361 727 to more than $1.3 million per RSV-related hospitalization avoided in children up to 2 years of age with chronic lung disease and no additional risk factors. Younger age and multiple indications were associated with improvements in the incremental cost-effectiveness ratio.
The cost of immunoprophylaxis with palivizumab far exceeded the economic benefit of preventing hospitalizations, even in infants at highest risk for RSV infection.