Direct Expenditures Related to Otitis Media Diagnoses: Extrapolations From a Pediatric Medicaid Cohort

Abstract

ABSTRACT. Background. Treatment of otitis media in children is associated with substantial expenditures because of its high frequency during childhood. Vaccines against respiratory pathogens causing otitis media are now being developed. Information about otitis mediarelated medical expenditures will be needed to determine the cost-effectiveness of these preventive interventions.Methods. This study used utilization data from claims to impute otitis media-related expenditures for medical visits, pharmaceuticals, and surgical procedures for 87 057 children 13 years of age and younger who were continuously enrolled in Colorado's fee-for-service Medicaid program during 1992. International Classification of Disease, Ninth Revision diagnostic codes were used to identify visits for otitis media. An antibiotic was considered to have been prescribed to treat otitis media if it was dispensed up to 24 hours before or within 48 hours after a physician encounter showing a diagnosis of otitis media. All tympanostomies, mastoidectomies, and adenoidectomies were assumed to be related to otitis media. Expenditures were imputed from utilization using a Medicaid fee schedule.National expenditures for 1992 to treat otitis media were extrapolated from Colorado's Medicaid data. We adjusted for differences between Colorado and the United States as a whole in terms of price, number, and intensity of services; for differences in reimbursement rates by service between Medicaid and private insurance; and for differences in utilization between Medicaid enrollees and the uninsured. To provide a more current expression of medical expenditures for otitis media, we inflated the 1992 expenditure estimates to 1998 dollars using the Consumer Price Index published by the US Bureau of Labor Statistics.Results. Twenty-eight percent of children experienced at least 1 episode of diagnosed otitis media. The proportion of children with a diagnosis of otitis media was highest (42%-60%) in the 7-month to 36-month age range. The proportion was also higher among white (34.5%) and Hispanic (25.3%) children than among black children (18.5%), as well as among rural (34.5%) compared with urban children (27.2%).Children 19 to 24 months of age incurred the highest total annual expenditures per child with otitis media ($239.68). Expenditures for drugs, visits, and procedures were all highest for this group. The per-patient cost to Medicaid was greater for visits than for drugs or procedures across all age groups.Total per-patient expenditures were higher for males ($174.67) than for females ($154.47) and higher for white children ($176.59) than for Hispanic ($154.12) or black children ($134.44). The differences among the ethnic groups can be attributed almost entirely to differences in expenditures for procedures and drugs. Although mean expenditures per patient varied substantially by some patient characteristics (eg, race), these differences accounted for only a small fraction of the enormous variation in costs per patient.Including children with and without otit...

Comprehensive Proteomic and Metabolomic Signatures of Nontypeable Haemophilus influenzae-Induced Acute Otitis Media Reveal Bacterial Aerobic Respiration in an Immunosuppressed Environment

“…S1) and the contralateral ear was processed for validation by microscopy or extraction of RNA or protein. Insufficient material was obtained from only one ear of the majority of sham-treated animals requiring pooling 1 The abbreviations used are: OM, otitis media; 12S-HHTrE, 12S-hydroxyheptadecatrienoic acid; 13-HDoHE, 13-hydroxydocosahexaenoic acid; 16-HDoHE, 16-hydroxydocosahexaenoic acid; 13-HpODE, 13(S)-hydroperoxyoctadeca-9Z,11E-dienoic acid; 15-HETE, 15-hydroxyeicosatetraenoic acid; 5-HETE, 5-Hydroxyicosatetraenoic acid; 9-HODE, 9-hydroxyoctadecadienoic acid; AI-2, autoinducer 2; AOM-acute otitis media; Arp-actin related protein; AUC-area under the curve; BEGM-bronchial epithelial cell growth medium; BHT-butylated hydroxytoluene; BiNGO, biological network gene ontology; CCR-7, C-C chemokine receptor type 7; CE-collision energy; ChoP, phosphorylcholine; DIA, Data Independent Analysis; DDA, Data Dependent Analysis; DMSO, dimethyl sulfoxide; DIS-defined iron source; DPBS-phosphate buffered saline; FIA, Flow Injection Analysis; FIA-MS/MS, Flow Injection Analysis Tandem Mass Spectrometry; Gln-glutamine; GMFG, glia maturation factor G; GMFG-glia maturation factor G; GO, gene ontology; HRP-horse radish peroxidase; IRF3, Interferon regulatory factor 3; KEGG, Kyoto Encyclopedia of Genes and Genomes; LLOQ, Lower limit of quantification; LOD, Limit of Detection; LPS, lipopolysaccharide; Lys-lysine; MAPK, mitogenactivated protein kinase; MRM-multiple reaction mode; NAD, nicotinamide adenine dinucleotide; NADPH, nicotinamide adenine dinucleotide phosphate (reduced); NF-kB, nuclear factor kappalight-chain-enhancer of activated B cells; NHBE-normal human bronchial epithelial; NTHI-nontypeable Haemophilus influenzae; OME-otitis media with effusion; Orn-ornithine; PAD, peptidyl arginine deiminase; PAF, platelet activating factor; PC, phosphatidylcholine; PC aa, Diacyl phosphatidylcholine; PC ae, Acyl-alkyl phophatidylcholine; PCA-principal components analysis; PLGS ProteinLynx Global Server; QC-quality control; qRT-PCR-quantitative reverse transcription-PCR; TLR4, toll-like receptor 4; UPLCultra performance liquid chromatography. of the two ears from each animal for multiomic analysis.…”

“…Otitis media (OM) 1 is a significant disease of the pediatric population. The direct and indirect costs for the diagnosis and treatment of acute OM (AOM) in 2009 approached $3 billion and the number of all OM cases has estimated costs of treatment of up to $6 billion in the US annually (1)(2)(3).…”

“…The direct and indirect costs for the diagnosis and treatment of acute OM (AOM) in 2009 approached $3 billion and the number of all OM cases has estimated costs of treatment of up to $6 billion in the US annually (1)(2)(3). The scope of the problem is apparent with the observation that globally there are 709 million cases of AOM estimated per year of which 51% occur in children under the age of five (4).…”

Prediction of Fluid Characteristics in Pediatric Otitis Media with Effusion from the Tympanometry

“…Otitis media with effusion (OME) is one of the most common disorders of childhood [1]. Bluestone and Klein defined OME as an inflammation of the middle ear with a collection of fluid in the middle ear space [2].…”

Adaptive Immunity in the Middle Ear Mucosa with Chronic Otitis Media

“…It is one of the most common infectious diseases in young children, accounting for frequent physician's office visits, tympanic membrane surgeries, and antimicrobial therapy in the United States [1] and is responsible for over $4 billion in annual health care costs and prompts more antibiotic prescriptions [2]. Approximately 5-10% of these patients turn into chronic otitis media (COM), for some reasons.…”