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Economic evaluation of ventilation tubes in otitis media with effusion
M Hartman1, M M Rovers, K Ingels
1Department of Medical Technology Assessment (253 MTA), University Medical Centre St Radboud, PO Box 9101, 6500 HB Nijmegen, the Netherlands. M.Hartman@mie.kun.nl
Insights
Ventilation tubes for persistent otitis media with effusion in children did not improve language development compared to watchful waiting. Watchful waiting is more cost-effective, costing significantly less per child.
Area of Science:
- Pediatric Otolaryngology
- Health Economics
- Evidence-Based Medicine
Background:
- Persistent otitis media with effusion (OME) is common in young children.
- Treatment decisions involve balancing potential benefits against costs and risks.
Purpose of the Study:
- To compare the costs and effectiveness of ventilation tubes versus watchful waiting for persistent OME in children.
- To evaluate impacts on effusion duration and language development.
Main Methods:
- Randomized controlled trial involving 187 young children with persistent bilateral OME.
- Interventions included ventilation tubes or watchful waiting.
- Outcomes measured: time without effusion, language development, and societal costs over 1 year.
Main Results:
- Ventilation tubes reduced effusion duration (4.7 months) compared to watchful waiting (9.2 months).
- Language development was comparable between groups (0.7 month difference).
- Ventilation tubes incurred higher costs ($454/child) versus watchful waiting ($120/child).
Conclusions:
- Ventilation tube treatment is not recommended as standard care for all young children with persistent OME due to comparable language outcomes and significantly higher costs.
- Watchful waiting presents a more cost-effective approach in the absence of demonstrable language benefits.
Objective:
To determine the costs and effectiveness of treatment with ventilation tubes as compared with watchful waiting in children with persistent otitis media with effusion.
Design:
Randomized controlled trial.
Setting:
Institutional practice.
Patients:
A total of 187 young children (19 months old) with persistent bilateral otitis media with effusion.
Interventions:
Treatment with ventilation tubes or watchful waiting.
Main Outcome Measures:
The time without effusion, language development, and the costs from a societal perspective during 1-year follow-up.
Results:
The mean duration of effusion was 9.2 months in the watchful waiting group and 4.7 months in the ventilation tube group. The language development was comparable in both groups (0.7 month of improvement difference [95% confidence interval, -0.3 to 1.7 months] after correction for confounding variables). Because no statistically significant differences were found in the language development between the treatment groups, we performed a cost minimization analysis. The mean costs per child during 1 year of follow-up were 454 US dollars in the ventilation tube group and 120 US dollars in the watchful waiting group. On average, an additional investment of 334 US dollars per patient was needed for ventilation tube treatment.
Conclusion:
In the absence of differences in language development and in view of higher costs, treatment with ventilation tubes is not recommended as standard treatment in all young children with persistent otitis media with effusion traced by a population-based screening program.