Healthcare consumption among subjects with otitis media undergoing middle ear surgery—analysis of cost drivers

Abstract

Purpose To map healthcare utilized by subjects with chronic otitis media, with or without cholesteatoma and perform a cost analysis to determine key drivers of healthcare expenditure. Methods A registry study of 656 adult subjects with chronic otitis media that underwent a middle ear surgery between 2014 and 2018. Healthcare contacts related to all publicly funded specialist ENT care, audiological care and primary care for a disease of the ear and mastoid process were extracted. The data are extracted from the Swedish National Patient Registry on subjects that reside in western Sweden. Results Subjects made 13,782 healthcare contacts at a total cost 61.1 million SEK (6.0 million EUR) between 2014 and 2018. The mean cost per subject was 93,075 SEK (9071 EUR) and ranged between 3971 SEK (387 EUR) and 468,711 SEK (45,683 EUR) per individual. In the most expensive quartile of subjects, mean cost was 192,353 SEK (18,747 EUR) over the 5-year period. These subjects made 3227 ENT contacts (roughly four each year) and 60% of total costs were associated with in-patient ENT care. Conclusion Patients with chronic otitis media are associated with high ENT resource utilization that does not diminish after surgical intervention and the disease places a long-term burden on healthcare systems. Significant costs are attributed to revision surgeries, indicating that these patients could be managed more effectively. In many such cases, reoperation cannot be avoided, especially due to recurrence of cholesteatoma. However, in some patients, when the indication for subsequent surgery is only hearing improvement, alternative options, such as hearing aids or implants, should also be considered. This is especially true in difficult cases, where revision ossiculoplasty is likely.

Modern Trends in Otologic Surgery and Implications for Residency Training

“…Traditional and bone-anchored hearing aid technology has improved over the last decades, and this, along with patients' increased comfort with devices, may be contributing. 21,22 Also, the management of cholesteatoma has changed in recent years, with more reliance on MRI 23 and endoscopy. 24 These factors may be contributing to fewer ossicular chain sacrifices, as well as fewer revision surgeries.…”

“…Any suggestion on a causality for the decline in ossiculoplasty would be speculation, but it must reflect either (1) a decrease in willingness to perform the procedure because there are better alternatives or (2) a decrease in pathology. Traditional and bone‐anchored hearing aid technology has improved over the last decades, and this, along with patients' increased comfort with devices, may be contributing 21,22 . Also, the management of cholesteatoma has changed in recent years, with more reliance on MRI 23 and endoscopy 24 .…”