Cost-effectiveness of Prednisolone to Treat Bell Palsy in Children

Background and Objectives:

Bell's palsy is the third most frequent diagnosis in children with sudden onset neurological dysfunction. The cost-effectiveness of treating Bell's palsy with prednisolone in children is unknown. We aimed to assess the cost-effectiveness of prednisolone in treating Bell's Palsy in children compared with placebo.

Methods:

This economic evaluation was a prospectively planned secondary analysis of a double-blinded, randomized, placebo-controlled superiority trial (BellPIC) conducted from 2015 to 2020. Time horizon was 6 months since randomization. Children aged 6 months to <18 years who presented within 72 hours of onset of clinician diagnosed Bell's palsy and who completed the trial were included (N=180). Interventions were oral prednisolone, or taste matched placebo administered for 10 days. Incremental cost-effectiveness ratio comparing prednisolone with placebo was estimated. Costs were considered from a healthcare sector perspective and included Bell's palsy related medication cost, doctor visits and medical tests. Effectiveness was measured using quality-adjusted life-years (QALYs) based on Child Health Utility 9D. Nonparametric bootstrapping was performed to capture uncertainties. Pre-specified sub-group analysis by age 12-18 years versus <12 years was conducted.

Results:

The mean cost per patient was A$760 in the prednisolone group and A$693 in the placebo group over the 6-month period (difference A$66, 95% confidence interval [CI]: -A$47, A$179). QALYs over 6-months was 0.45 in the prednisolone group and 0.44 in the placebo group (difference 0.01, 95%CI: -0.01, 0.03). The incremental cost to achieve one additional recovery was estimated to be A$1577 using prednisolone compared with placebo, and cost per additional QALY gained was A$6625 using prednisolone compared with placebo. Given a conventional willingness-to-pay threshold of A$50,000 per QALY gained (equivalent to US$35,000 or £28,000), prednisolone is very likely cost-effective (probability is 83%), . Sub-group analysis suggests that this was primarily driven by the high probability of prednisolone being cost-effective in children aged 12-18 years (probability is 98%) and much less so for those <12 years (probability is 51%).

Discussion:

This provides new evidence to stakeholders and policy makers when considering whether to make prednisolone available in treating Bell's palsy in children aged 12-18 years.

Trial Registration:

Australian New Zealand Clinical Trials Registry ACTRN12615000563561.