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Recurrent otitis media: a cost-utility analysis of simulated treatment using tympanostomy tubes vs antibiotic
R S Bisonni1, F H Lawler, L Pierce
1Department of Family Medicine, Oklahoma University Health Sciences Center, Oklahoma City.
Insights
For recurrent otitis media, antibiotic chemoprophylaxis is more cost-effective than tympanostomy tubes (T-tubes). T-tubes should be reserved for cases that do not respond to initial antibiotic treatment.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Health Economics
Background:
- Recurrent otitis media (ROM) significantly impacts children's health and healthcare costs.
- Current treatment options include tympanostomy tubes (T-tubes) and antibiotic chemoprophylaxis.
- A comparative analysis of cost-effectiveness for these treatments is crucial.
Purpose of the Study:
- To compare the cost-utility of T-tubes versus antibiotic chemoprophylaxis for managing recurrent otitis media in young patients.
- To determine the preferred initial treatment strategy based on economic and clinical outcomes.
Main Methods:
- A cost-utility analysis was performed using a decision-analytic model.
- Effectiveness was measured by net utility, incorporating costs and health benefits.
- Two treatment strategies were modeled: T-tube insertion and continuous antibiotic chemoprophylaxis.
Main Results:
- Antibiotic chemoprophylaxis was found to be more cost-effective ($281.30) than T-tubes ($396.44) in the base case scenario.
- The chemoprophylaxis strategy yielded a higher net utility (.9476) compared to T-tubes (.9325).
- Sensitivity analyses indicated that this conclusion remained robust under various assumptions.
Conclusions:
- Initial management of recurrent otitis media should involve acute antibiotics followed by chemoprophylaxis.
- Tympanostomy tubes are recommended as a secondary treatment for cases refractory to initial medical management.
- The findings support the preferential use of antibiotic chemoprophylaxis for its superior cost-utility in treating recurrent otitis media.
Abstract:
Using a cost-utility analysis, the effectiveness of tympanostomy tubes was compared to that of antibiotic chemoprophylaxis in young patients with recurrent otitis media. The tympanostomy approach (T-tubes) consisted of placement of a polyethylene grommet in the tympanic membrane, with systemic and local antibiotics administered for one week. The chemoprophylaxis approach consisted of antibiotics in full doses for seven to ten days, followed by continuous antibiotic chemoprophylaxis for six months. Because the T-tube strategy under the model assumptions was more expensive ($396.44 vs $281.30) and yielded slightly less benefit (net utility of .9325 vs. .9476 for initial antibiotic therapy), the chemoprophylaxis option was preferred. We conclude that the initial treatment for recurrent otitis media should consist of acute antibiotics followed by chemoprophylaxis, with T-tubes reserved for treatment failure. Extreme changes in the baseline probabilities of cure or recurrence with antibiotic therapy or in the cost of antibiotic therapy or tympanostomy surgery were required to alter this conclusion. Varying therapy preference (utility) values did not materially alter the conclusions.