Published 9 September 2008, doi:10.1136/bmj.a1490
Cite this as: BMJ 2008;337:a1490

Research

Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): economic evaluation of a randomised controlled trial

¹ Academic Unit of Primary Health Care, NIHR National School for Primary Care Research, Department of Community Based Medicine, University of Bristol, Bristol BS8 2AA, ² Faculty of Health and Social Care, University of the West of England, Bristol BS16 1QY

Objective To estimate the cost to the NHS and to parents and carers of treating febrile preschool children with paracetamol, ibuprofen, or both, and to compare these costs with the benefits of each treatment regimen.

Design Cost consequences analysis and cost effectiveness analysis conducted as part of a three arm, randomised controlled trial.

Participants Children between the ages of 6 months and 6 years recruited from primary care and the community with axillary temperatures 37.8°C and 41°C.

Interventions Paracetamol, ibuprofen, or both drugs.

Main outcome measures Costs to the NHS and to parents and carers. Cost consequences analysis at 48 hours and 5 days comparing cost with children’s temperature, discomfort, activity, appetite, and sleep; cost effectiveness analysis at 48 hours comparing cost with percentage of children "recovered."

Results Difficulties in recruiting children to the trial lowered the precision of the estimates of cost and some outcomes. At 48 hours, cost to the NHS was £11.33 for paracetamol, £8.49 for ibuprofen, and £8.16 for both drugs. By day 5 these costs rose to £19.63, £18.36, and £13.92 respectively. For parents and carers, the 48 hour costs were £23.86 for paracetamol, £20.60 for ibuprofen, and £25.07 for both, and the day 5 costs were £26.35, £29.90, and £24.02 respectively. Outcomes measured at 48 hours and 5 days were inconclusive because of lack of power; the cost effectiveness analysis at 48 hours provided little evidence that one treatment choice was significantly more cost effective than another. At 4 hours ibuprofen and the combined treatment were superior to paracetamol in terms of the trial primary outcome of time without fever; at 24 hours the combined treatment performed best on this outcome.

Conclusions There is no strong evidence of a difference in cost between the treatments, but clinical and cost data together indicate that using both drugs together may be most cost effective over the course of the illness. This treatment option performs best and is no more expensive because of less use of healthcare resources, resulting in lower costs to the NHS and to parents.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial

Alastair D Hay, Céire Costelloe, Niamh M Redmond, Alan A Montgomery, Margaret Fletcher, Sandra Hollinghurst, and Tim J Peters
BMJ 2008 337: a1302. [Abstract] [Full Text] [PDF]

What worries parents when their preschool children are acutely ill, and why: a qualitative study

Joe Kai
BMJ 1996 313: 983-986. [Abstract] [Full Text]

This article has been cited by other articles:

• Harnden, A. (2008). Antipyretic treatment for feverish young children in primary care. BMJ 337: a1409-a1409 [Full text]  

Rapid Responses:

Read all Rapid Responses

Beyond costs

Carlos A Calderon Ospina, et al.
bmj.com, 11 Sep 2008 [Full text]

Flawed economic evaluation of PITCH

Wouter Havinga
bmj.com, 29 Sep 2008 [Full text]

Online poll

Find out more on doc2doc >>