Corticosteroids in the management of moderate or severe asthmatic crises: oral or intravenous? Implications concerning costs and effectiveness

¿Corticosteroides orales o endovenosos en el manejo de la crisis asmática moderada o severa? Implicaciones de costos y efectividad

Objective: to determine whether orally administered corticosteroids are more effective and less costly than intravenous corticosteroids for the management of moderate or severe asthmatic crises.

Design: a cost-minimization study was performed using decision analysis.

Materials and methods: the study was carried out at Hospital Universitario de San Ignacio of Bogotá (Colombia), a privately owned, third level institution. Determination of costs and resources utilized was done by reviewing the clinicahistories of patients with asthma who received care over the period 1988-1997. A projection was done for 1.000 subjects receiving care for that ailment. Determination of the effectiveness or oral vs. intravenous corticosteroids was
based on a meta-analysis.

Results: the patients received, on average, 4 days of therapy with intravenous corticosteroids; the cost of this medication for 1.000 persons is thus $ 148.404.000, whereas the cost of oral prednisolone or its equivalent at 1 mg/kg/day would have been $ 8.493.000 (5,7%). Two meta-analyses found in the literature demonstrated that the activity of oral and intravenous corticosteroids was similar, and that, unless there is some contraindication for oral administration, the effects on the patients are also similar.

Conclusions: since the efficacy of oral corticosteroids is similar to that of intravenous corticosteroids in the management of asthmatic crises, and since the cost of oral therapy is much lower, it is recommended that patients should receive therapy with oral corticosteroids, except when the oral route is contraindicated