Cost-effectiveness of treatment of acute otorrhea in children with tympanostomy tubes

Acute otorrhea is a common problem in children with tympanostomy tubes. We recently demonstrated that treatment with antibiotic-glucocorticoid eardrops is clinically superior to oral antibiotics and initial observation. The aim of this study was to assess the cost-effectiveness of these three common...

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Published in:Pediatrics (Evanston) Vol. 135; no. 5; pp. e1182 - e1189
Main Authors: van Dongen, Thijs M A, Schilder, Anne G M, Venekamp, Roderick P, de Wit, G Ardine, van der Heijden, Geert J M G
Format: Journal Article
Language:English
Published: United States 01.05.2015
Subjects:
Acute Disease
Anti-Bacterial Agents - economics
Anti-Bacterial Agents - therapeutic use
Body Fluids
Child, Preschool
Cost-Benefit Analysis
Ear Diseases - drug therapy
Ear Diseases - economics
Glucocorticoids - economics
Glucocorticoids - therapeutic use
Humans
Middle Ear Ventilation - instrumentation
Postoperative Complications - drug therapy
Postoperative Complications - economics
epidemiology
otitis media
ISSN:1098-4275
Online Access:Get more information
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Summary:Acute otorrhea is a common problem in children with tympanostomy tubes. We recently demonstrated that treatment with antibiotic-glucocorticoid eardrops is clinically superior to oral antibiotics and initial observation. The aim of this study was to assess the cost-effectiveness of these three common treatment strategies for this condition. We performed an open-label pragmatic trial in which 230 children with acute uncomplicated tympanostomy-tube otorrhea were randomly allocated to receive 1 of 3 treatments: hydrocortisone-bacitracin-colistin eardrops, oral amoxicillin-clavulanate suspension, and initial observation (no assigned medication prescription to fill). Parents kept a daily diary capturing ear-related symptoms, health care resource use, and non-health care costs for 6 months. At 2 weeks and 6 months, the study doctor visited the children at home performing otoscopy. Using a societal perspective, treatment failure (otoscopic presence of otorrhea at 2 weeks) and number of days with otorrhea as reported in the daily diary were balanced against the costs. Antibiotic-glucocorticoid eardrops were clinically superior to oral antibiotics and initial observation both at 2 weeks and 6 months. At 2 weeks, mean total cost per patient was US$42.43 for antibiotic-glucocorticoid eardrops, US$70.60 for oral antibiotics, and US$82.03 for initial observation. At 6 months, mean total cost per patient was US$368.20, US$420.73, and US$640.44, respectively. Because of the dominance of eardrops, calculating incremental cost-effectiveness ratios was redundant. Antibiotic-glucocorticoid eardrops are clinically superior and cost less than oral antibiotics and initial observation in children with tympanostomy tubes who develop otorrhea.
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ISSN:1098-4275
DOI:10.1542/peds.2014-3141