# The probability of reducing hospitalization rates for bronchiolitis with epinephrine and dexamethasone: A Bayesian analysis

## TL;DR

This study uses Bayesian analysis to show that combining epinephrine and dexamethasone likely reduces hospitalization rates for bronchiolitis in infants.

## Contribution

The paper introduces a Bayesian approach to assess the probability of treatment effectiveness in bronchiolitis management.

## Key findings

- A Bayesian analysis shows a high probability that EpiDex reduces hospitalization rates.
- There is a 90% probability of a clinically meaningful 10% reduction in hospitalizations with EpiDex.
- Results suggest a 67% probability of benefit even with strongly skeptical prior assumptions.

## Abstract

Bronchiolitis exerts a high burden on children, their families and the healthcare system. The Canadian Bronchiolitis Epinephrine Steroid Trial (CanBEST) assessed whether administering epinephrine alone, dexamethasone alone, or in combination (EpiDex) could reduce bronchiolitis-related hospitalizations among children less than 12 months of age compared to placebo. CanBEST demonstrated a statistically significant reduction in 7-day hospitalization risk with EpiDex in an unadjusted analysis but not after adjustment.

To explore the probability that EpiDex results in a reduction in hospitalizations using Bayesian methods.

Using prior distributions that represent varying levels of preexisting enthusiasm or skepticism, i.e., how confident or doubtful one is that EpiDex may reduce hospitalizations, and information about the treatment effect before data were collected, the posterior distribution of the relative risk of hospitalization compared to placebo was determined. The probability that the treatment effect is less than 1, 0.9, 0.8 and 0.6, indicating increasing reductions in hospitalization risk, are computed alongside 95% credible intervals.

Combining a minimally informative prior distribution with the data from CanBEST provides comparable results to the original analysis. Unless strongly skeptical views about the effectiveness of EpiDex were considered, the 95% credible interval for the treatment effect lies below 1, indicating a reduction in hospitalizations. There is a 90% probability that EpiDex results in a clinically meaningful reduction in hospitalization of 10% even when incorporating skeptical views, with a 67% probability when considering strongly skeptical views.

A Bayesian analysis demonstrates a high chance that EpiDex reduces hospitalization rates for bronchiolitis, although strongly skeptical individuals may require additional evidence to change practice.

Clinical Trial registry name, registration number: Current Controlled Trials number, ISRCTN56745572