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Variation in Utilization and Need for Tympanostomy Tubes across England and New England
Devin M Parker1, Laura Schang2, Jared R Wasserman3
1The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Insights
Tympanostomy tube insertion rates for otitis media with effusion vary significantly between England and Northern New England. England shows overall underuse, while Northern New England exhibits both overuse and underuse, suggesting disparities unrelated to medical need.
Area of Science:
- Otolaryngology
- Pediatric Health Services Research
- Epidemiology
Background:
- Otitis media with effusion (OME) is a common childhood condition requiring medical attention.
- Tympanostomy tubes are frequently inserted to treat OME and associated hearing loss.
- Variations in OME treatment rates suggest potential disparities in healthcare access and utilization.
Purpose of the Study:
- To compare the observed rates of tympanostomy tube insertions for OME with estimated needs in England and Northern New England (NNE).
- To investigate regional variations in OME treatment and their correlation with estimated disease prevalence.
Main Methods:
- A cross-sectional analysis of all-payer claims data for children aged 2-8 years (2007-2010) in NNE and English Primary Care Trusts (PCTs).
- Rates of tympanostomy tube insertions were calculated across Pediatric Surgical Areas (PSA) in NNE and PCTs in England.
- Observed rates were compared with expected rates derived from a Monte Carlo simulation model integrating clinical guidelines and OME incidence probabilities.
Main Results:
- Observed tympanostomy tube insertion rates varied widely across English PCTs (>30-fold) and NNE PSAs (>3-fold).
- England demonstrated an overall deficit of -3.41 tubes per 1000 child-years compared to expected rates (25 dB hearing threshold).
- NNE showed a smaller deficit (-0.01 per 1000 child-years), with some areas exhibiting higher-than-expected insertion rates, indicating an inverse relationship between need and observed rates.
Conclusions:
- Significant regional variations in tympanostomy tube insertion rates exist, independent of estimated need.
- England experiences overall underuse of tympanostomy tubes for OME.
- Northern New England presents a mixed picture of both overuse and underuse, highlighting the need for further investigation into care patterns.
Objectives:
To compare rates of typmanostomy tube insertions for otitis media with effusion with estimates of need in 2 countries.
Study Design:
This cross-sectional analysis used all-payer claims to calculate rates of tympanostomy tube insertions for insured children ages 2-8 years (2007-2010) across pediatric surgical areas (PSA) for Northern New England (NNE; Maine, Vermont, and New Hampshire) and the English National Health Service Primary Care Trusts (PCT). Rates were compared with expected rates estimated using a Monte Carlo simulation model that integrates clinical guidelines and published probabilities of the incidence and course of otitis media with effusion.
Results:
Observed rates of tympanostomy tube placement varied >30-fold across English PCT (N = 150) and >3-fold across NNE PSA (N = 30). At a 25 dB hearing threshold, the overall difference in observed to expected tympanostomy tubes provided was -3.41 per 1000 child-years in England and -0.01 per 1000 child-years in NNE. Observed incidence of insertion was less than expected in 143 of 151 PCT, and was higher than expected in one-half of the PSA. Using a 20 dB hearing threshold, there were fewer tube insertions than expected in all but 2 England and 7 NNE areas. There was an inverse relationship between estimated need and observed tube insertion rates.
Conclusions:
Regional variations in observed tympanostomy tube insertion rates are unlikely to be due to differences in need and suggest overall underuse in England and both overuse and underuse in NNE.
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