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Payment analysis of two diagnosis and management approaches of acute otitis media

Janet R Casey1, Michael E Pichichero2

  • 1Legacy Pediatrics, Rochester, NY, USA.

Clinical Pediatrics
|May 13, 2014
PubMed

Insights

A new diagnosis strategy for acute otitis media (AOM) in children significantly reduced AOM diagnoses and treatment costs. This approach could save over $1 billion annually in the US.

Area of Science:

  • Pediatrics
  • Health Economics
  • Infectious Diseases

Background:

  • Acute otitis media (AOM) is a common childhood infection with varying diagnostic criteria and treatment approaches.
  • Current management strategies for AOM can lead to overdiagnosis and overtreatment, increasing healthcare costs.
  • The economic burden of AOM management necessitates exploring cost-effective diagnostic and therapeutic pathways.

Purpose of the Study:

  • To compare the cost of care for two distinct diagnostic and management strategies for AOM in children aged 6 to 30 months.
  • To evaluate the impact of a stricter diagnostic criterion (bulging tympanic membrane) on AOM diagnosis rates, recurrence, and tympanostomy tube insertion.
  • To estimate the potential national cost savings associated with the proposed diagnostic and management approach for AOM.

Main Methods:

  • A case-control study design was employed, comparing children diagnosed with AOM based on a bulging tympanic membrane (cases) to those diagnosed without this criterion (controls).
  • Data on diagnosis, treatment, recurrence, tympanostomy tube insertion, and associated direct and indirect costs were collected and analyzed.
  • Statistical analysis, including P-values, was used to determine significant differences between the case and control groups.

Main Results:

  • Fewer children in the case group (49%) were diagnosed with AOM compared to the control group (69%) (P < .001).
  • The case group exhibited significantly lower rates of recurrent AOM or treatment failure (0.34 vs 1.6/child; P < .0001) and tympanostomy tube insertions (6.3% vs 14.8%; P < .0001).
  • The cost of care was substantially lower for the case group ($539/case) compared to the control group ($1,023/control).

Conclusions:

  • A diagnostic approach for AOM requiring a bulging tympanic membrane leads to fewer diagnoses, reduced recurrence, and fewer tympanostomy tube insertions.
  • This targeted diagnostic strategy significantly lowers the overall cost of AOM management.
  • Implementing this approach nationally could result in substantial healthcare cost savings, estimated at over $1 billion annually.

Keywords:
acute otitis mediaantibioticsguidelinespayment analysistympanostomy tubes

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