Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media

Abstract

PURPOSE This study evaluated the costs and utility of observation and routine antibiotic treatment options for children with acute otitis media. METHODSThe cost-effectiveness analysis was performed among children aged 6 months to 12 years seen in primary care offi ces. The interventions studied were watchful waiting as practiced in the Netherlands, delayed prescription, 5 days of amoxicillin, and 7 to 10 days of amoxicillin. The main outcome measure was cost per quality-adjusted life-year (QALY). RESULTSIn the base case analysis, delayed prescription was the least costly option and 7 to 10 days of amoxicillin was the most effective. The incremental cost utility ratio (ICUR) of 7 to 10 days of amoxicillin compared with delayed prescription was $56,000 per QALY gained. Watchful waiting and 5 days of amoxicillin were inferior options. The results were sensitive to the rate of nonattendance in the delayed prescription strategy: when the rate was less than 23%, watchful waiting was the least costly option and delayed prescription was an inferior option. Probabilistic sensitivity analysis, in which all model variables were simultaneously varied, showed with 95% certainty that compared with delayed prescription, 7 to 10 days of amoxicillin had a 61% probability of having an ICUR of greater than $50,000 per QALY gained, and watchful waiting had a 23% probability of having an ICUR of less than $50,000 per QALY gained.CONCLUSIONS Economically, an approach to the treatment of acute otitis media with either an initial period of observation or routine treatment with amoxicillin is reasonable. INTRODUCTIONA cute otitis media (AOM), or infl ammation of the middle ear, is responsible for 13.6 million pediatric offi ce visits annually in the United States 1 at an estimated annual cost of $2.98 billion in 1995. 2 In the United States, AOM is routinely treated with antibiotics and, because of the large number of visits, accounts for a considerable percentage of all outpatient antimicrobial prescriptions. 3,4 The benefi t of antibiotic treatment of AOM is controversial, however, for children older than 6 months. [5][6][7][8] Meta-analyses and systematic reviews of the literature have found a spontaneous resolution rate of 81% compared with a 93% resolution rate with antibiotic therapy, for an overall benefi t of shortening the course of AOM by 1 day in 1 of 8 children treated. [9][10][11][12] Suppurative complications, such as acute mastoiditis, are rare, 13 and the extensive use of antibiotics contributes to bacterial resistance. [14][15][16][17][18][19][20] Several recent reports document the effi cacy and safety of 2 alternative, observational approaches to routine use of antibiotics: delayed prescription and watchful waiting. [21][22][23][24] These approaches involve waiting for 72 hours to see if symptoms improve before instituting antibiotic therapy. Routine antibiotic treatment is the usual option for treating AOM in the United States, but recent guidelines have allowed for observation of chil- T R E AT MEN T O P ...

Reducing the costs of paediatric antibiotic prescribing in the community by implementing guideline recommendations

“…At the international level, several cost analysis studies have been published concerning treatment of pharyngitis and acute otitis media, the most common infectious diseases in paediatric outpatients . A Finnish study concluded that the implementation of the guidelines on acute otitis media in children is associated with extra health benefits at slightly lower direct costs .…”

Air Pollution and Emergency Department Visits for Otitis Media: A Case-Crossover Study in Edmonton, Canada

“…The costs and utility of observation and routine antibiotic treatment options for children with acute OM are in the range from $132 to $157 in the United States (Coco 2007). It is a common childhood illness that is one of the most frequent reasons for medical visits and antibiotic prescriptions (Rovers 2008).…”

Ear discharge in children presenting with acute otitis media: observational study from UK general practice

“…While antibiotics may benefit some children, pain relief is not immediate, the average reduction in duration of pain is only a few hours, and there is no impact on long-term hearing or ear, nose, and throat (ENT) referrals. [2][3][4][5][6][7][8][9][10] However, the NICE guidance does recommend that GPs should 'consider' immediate antibiotic treatment for two groups of children with acute otitis media -the very young (age <2 years) and those with ear discharge. The stated justification for the latter is that a posthoc meta-analysis of the clinical trial data suggests that only three children need to be treated for one less child to experience pain or fever at the 3-7-day assessment point.…”