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Appendix A

Cost-effectiveness of IVT versus ORT for children with

dehydration

Introduction

Acute diarrhoea with or without vomiting accounts for approximately 20% of general practitioner
consultations and more than 12% of emergency department presentations each year, clearly a
substantial proportion of NHS resources. There are wide variations in current practice in both
primary and secondary care in the methods of rehydration therapy for treating children presenting
with dehydration. The GDG identified a single clinical question comparing the effectiveness and
safety of oral rehydration therapy (ORT) against intravenous fluid therapy (IVT) in children with
dehydration. The GDG thought that economic considerations would be particularly important in
formulating recommendations for this question.

Literature review

A systematic search for published economic evidence was undertaken for this question. The
initial search identified approximately 21 articles. An initial screen was used to exclude papers
that were clearly not relevant to the research question being addressed and from this six papers
were retrieved for further examination. In selecting studies for the review, the main exclusion
criteria were as follows:
• primary studies set in developing or low-income countries
• papers in a language other than English
• papers published before 1990
• abstracts
• evidence not related specifically to the clinical or cost-effectiveness of ORT or IVT.
From the six retrieved papers, only one 205 was identified as an economic evaluation.
This study aimed to compare nasogastric and IV methods of rehydration for children with acute
dehydration in a US setting for children aged between 3 and 36 months presenting with acute
dehydration caused by vomiting and/or diarrhoea. Before the study began, all children attempted
an oral fluid challenge (OFC). Those unable to tolerate oral fluids as a means of resolving their
dehydration were enrolled into the study. The children were then randomly assigned to receive
either rapid intravenous hydration (RIV) or rapid nasogastric hydration (RNG) over a period of
3 hours within the emergency department. Patients were also given an OFC before being allowed
to be discharged from hospital.
The study reported average per-patient costs for both treatments that included laboratory, supply
and staff costs. The cost analysis aimed to measure any saving as a result of using RNG over
RIV. The authors did not report any significant complications for RNG; RIV was reported to be
complicated by repeated catheter insertions that the authors felt resulted in greater inconvenience,
pain and an increased overall cost of care.
No statistical difference in outcomes was found between the two treatment options and the authors
therefore conclude that RNG was more cost-effective than RIV, on cost alone. Furthermore, the
authors noted that both RIV and RNG were cost-effective alternatives to standard treatment (IVT).
The authors also concluded that RNG has fewer associated complications in comparison with RIV.
This study could not be used alone as a basis to guide recommendations on IVT and ORT. It
focused on nasogastric methods of rehydration (as a subset of ORT) and rapid IVT, whereas the

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