Tympanostomy tube placement and ear drops: Evidence-based cost saving models

Tympanostomy tube placement is the most common surgical procedure in the pediatric population with important financial implications to our healthcare institutions. The purpose of this study is to apply various cost models in different clinical environments to determine the most cost effective way to prescribe ear drops after tympanostomy tube insertion.

Two distinct practice models were designed: a Uniform Treatment Model and a Disease Specific Model. Different cost simulations were run based on which medication(s) was chosen for all tympanostomy tube cases performed over the course of 1 year in a practice composed of four pediatric otolaryngologist. Two categories of ear drop medications were seen: high cost and low cost. The cost associated with initiation of drops in the operating room versus initiation as an outpatient via a prescription was evaluated.

In both Uniform Treatment and Disease Specific Models, the most expensive simulations included antibiotic/steroid combination drop use intraoperatively. The treatment with an antibiotic/steroid combination drop was lower when delayed until the post-operative period. The hospital cost for ear drops increased by as much as 478% when dispensed within the operating room rather than from the hospital's outpatient pharmacy.

Otolaryngologists should make an effort to become familiar with the cost of ototopical medications and the significant variability between inpatient and outpatient settings. Cost of ototopical agents should be shifted to the institution's outpatient pharmacy whenever possible especially for branded, higher cost combination drops. Patients should be treated based on the status of their ear disease at time of middle tube insertion.