Date Published: October 12, 2010
Publisher: Public Library of Science
Author(s): Stephen B. Freedman, Michael J. Steiner, Kevin J. Chan, Zulfiqar A. Bhutta
Abstract: Stephen Freedman and colleagues performed a cost analysis of the routine administration of ondansetron in both the United States and Canada and show that its routine administration to eligible children in such settings could provide substantial benefit.
Partial Text: The use of antiemetics for children with vomiting is one of the most controversial decisions in the treatment of gastroenteritis in developed countries . Although oral rehydration therapy (ORT) is recommended for children with mild to moderate dehydration, it remains underused ,. In one survey, over a third of pediatricians indicated that vomiting is a contraindication to ORT , while 86% of pediatric emergency medicine physicians who responded to a survey indicated that they are more likely to administer intravenous rehydration when vomiting is the major symptom . Physicians frequently prescribe antiemetic agents  because they are interested in increasing the success of ORT and reducing the discomforts of vomiting. However, antiemetic agents commonly used in the 1990s such as promethazine and prochlorperazine , are associated with frequent and potentially life-threatening side effects , which resulted in a negative perception of all antiemetics and a reduction in their use for children with gastroenteritis.
We estimate that every year, oral ondansetron administration to eligible children in the ED would prevent intravenous insertion in approximately 30,000 children in the US and 4,000 in Canada. Over 8,000 admissions per year would be avoided in these countries combined. Ondansetron administration to the appropriate group of children would additionally result in an incremental savings from the societal perspective of US$66 million per year in the US and CDN$1.7 million in Canada. Thus, it is clear that ondansetron administration to children with vomiting and dehydration in the ED is a dominant strategy (i.e. ondansetron administration results in improved outcomes and reduced costs).