Decision-making in otitis media in children, Part II: A cost-effectiveness analysis

Acute otitis media (AOM) is a source of considerable expense of money and care. Two protocols for the empirical treatment of AOM are compared by a cost-effectiveness analysis. In protocol 1, treatment is initiated by a standard-spectrum antibiotic (amoxicillin) for 5--7 days; in case of clinical failure, a second treatment is prescribed with a wide-spectrum antibiotic (cefaclor) for 7--10 days. In protocol 2, treatment with a standard-spectrum antibiotic is prescribed only in case of clinical failure after a 'masterful inactivity' for 3--5 days, then checked on days 5--7, for a prescription of a wide-spectrum antibiotic in case of failure. The two protocols have a similar effectiveness, but the cost of protocol 2 is significantly higher because of a greater expense for medical visits. A low compliance rate is a definite factor of high cost-effectiveness ratio.