Prednisolone Found To Be Cost Effective Treatment For Bell Palsy In Children

Bell palsy, a sudden-onset neurologic dysfunction, ranks as the third most common diagnosis in children. However, the cost-effectiveness of using prednisolone, a medication, in treating Bell palsy in children remains uncertain. A new study published in the journal Neurology aims to assess the cost-effectiveness of prednisolone compared to a placebo for the treatment of Bell palsy in children.

The study was a secondary analysis of a double-blinded, randomized, placebo-controlled trial called Bell Palsy in Children (BellPIC), conducted from 2015 to 2020 by researchers Xiuqin Xiong and team. The analysis considered a time horizon of 6 months since randomization and included children aged 6 months to under 18 years who sought medical attention within 72 hours of the onset of Bell palsy. A total of 180 participants who completed the trial were included in the analysis.

During the trial, the participants were administered either oral prednisolone or a taste-matched placebo for a period of 10 days. The cost-effectiveness of prednisolone versus placebo was evaluated by estimating the incremental cost-effectiveness ratio. The costs analyzed were from a healthcare sector perspective and included medication costs, doctor visits, and medical tests specifically related to Bell palsy. The effectiveness was measured in quality-adjusted life-years (QALYs) based on the Child Health Utility 9D tool. Uncertainties were addressed using nonparametric bootstrapping, and a subgroup analysis was conducted based on two age groups: 12 to under 18 years and under 12 years.

● The findings of the analysis revealed that the mean cost per patient over the 6-month period was A$760 in the prednisolone group and A$693 in the placebo group, with a difference of A$66 (95% CI -A$47 to A$179).

● The QALYs over 6 months were 0.45 in the prednisolone group and 0.44 in the placebo group, showing a difference of 0.01 (95% CI -0.01 to 0.03). The incremental cost to achieve one additional recovery was estimated to be A$1,577 when using prednisolone compared to placebo.

● Moreover, the cost per additional QALY gained was A$6,625 when using prednisolone compared to placebo.Based on the conventional willingness-to-pay threshold of A$50,000 per QALY gained, which is equivalent to US$35,000 or £28,000, the study indicated that prednisolone is highly likely to be cost-effective, with a probability of 83%.

● Subgroup analysis further suggested that this cost-effectiveness was primarily driven by the high probability of prednisolone being cost-effective in children aged 12 to under 18 years, with a probability of 98%, compared to those under 12 years, where the probability was 51%.

These findings offer valuable new evidence to stakeholders and policymakers when considering the availability of prednisolone for treating Bell palsy in children aged 12 to under 18 years. By assessing the cost-effectiveness of this intervention, the study provides important insights to inform decision-making and resource allocation in healthcare settings. Further research and consideration may be necessary to determine the optimal treatment approach for children under 12 years with Bell palsy.

Reference:

Xiong, X., Huang, L., Herd, D., Borland, M., Davidson, A., Hearps, S., Mackay, M. T., Lee, K. J., Dalziel, S. R., Dalziel, K., Cheek, J. A., & Babl, F. E. (2023). Cost-effectiveness of prednisolone to treat bell palsy in children: An economic evaluation alongside a randomized controlled trial. Neurology. https://doi.org/10.1212/WNL.0000000000207284.