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Cost-effectiveness analysis of treatment options for acute otitis media
1Von Hess Healthcare Research Center, Family and Community Medicine, Lancaster General Hospital, Lancaster, PA 17604-3555, USA. ascoco@lancastergeneral.org
Insights
For acute otitis media in children, delayed antibiotic prescription is cost-effective. Longer amoxicillin courses (7-10 days) are more effective but costly, while watchful waiting may be cheapest if nonattendance rates are high.
Area of Science:
- Pediatric infectious diseases
- Health economics
- Clinical decision-making
Background:
- Acute otitis media (AOM) is a common childhood illness.
- Treatment guidelines vary, with options including observation and antibiotics.
- Understanding the cost-effectiveness of different AOM management strategies is crucial for healthcare providers.
Purpose of the Study:
- To evaluate the costs and utility of observation versus routine antibiotic treatment for pediatric acute otitis media.
- To compare the cost-effectiveness of watchful waiting, delayed prescription, and different durations of amoxicillin therapy.
Main Methods:
- Cost-effectiveness analysis in children aged 6 months to 12 years.
- Interventions: watchful waiting, delayed prescription, 5-day amoxicillin, 7-10 day amoxicillin.
- Primary outcome: cost per quality-adjusted life-year (QALY) gained.
Main Results:
- Delayed prescription was the least costly; 7-10 day amoxicillin was most effective.
- The incremental cost utility ratio (ICUR) for 7-10 day amoxicillin vs. delayed prescription was $56,000/QALY.
- Watchful waiting and 5-day amoxicillin were inferior strategies. Results varied with nonattendance rates for delayed prescription.
Conclusions:
- Both observational approaches and routine amoxicillin treatment for AOM are economically viable.
- The optimal strategy depends on specific clinical context and cost-effectiveness thresholds.
Purpose:
This study evaluated the costs and utility of observation and routine antibiotic treatment options for children with acute otitis media.
Methods:
The cost-effectiveness analysis was performed among children aged 6 months to 12 years seen in primary care offices. The interventions studied were watchful waiting as practiced in the Netherlands, delayed prescription, 5 days of amoxicillin, and 7 to 10 days of amoxicillin. The main outcome measure was cost per quality-adjusted life-year (QALY).
Results:
In the base case analysis, delayed prescription was the least costly option and 7 to 10 days of amoxicillin was the most effective. The incremental cost utility ratio (ICUR) of 7 to 10 days of amoxicillin compared with delayed prescription was 56,000 dollars per QALY gained. Watchful waiting and 5 days of amoxicillin were inferior options. The results were sensitive to the rate of nonattendance in the delayed prescription strategy: when the rate was less than 23%, watchful waiting was the least costly option and delayed prescription was an inferior option. Probabilistic sensitivity analysis, in which all model variables were simultaneously varied, showed with 95% certainty that compared with delayed prescription, 7 to 10 days of amoxicillin had a 61% probability of having an ICUR of greater than 50,000 dollars per QALY gained, and watchful waiting had a 23% probability of having an ICUR of less than 50,000 dollars per QALY gained.
Conclusions:
Economically, an approach to the treatment of acute otitis media with either an initial period of observation or routine treatment with amoxicillin is reasonable.
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