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Cost-effectiveness of Inpatient Tympanostomy Prophylaxis
Heather Yeakel1, Luke J Pasick2, Gregory J Kirchner3
1Drexel University College of Medicine, Philadelphia, Pennsylvania.
Insights
Intraoperative antibiotic prophylaxis can be cost-effective for preventing post-tympanostomy otorrhea, a common complication of pediatric ear surgery. This analysis provides a model for physicians to assess intervention costs for patients and institutions.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Economics
Background:
- Tympanostomy is the most frequent pediatric ambulatory surgery.
- Post-tympanostomy otorrhea is a common complication with significant treatment costs.
- The cost-effectiveness of intraoperative prophylaxis for otorrhea has not been previously evaluated.
Purpose of the Study:
- To evaluate the cost-effectiveness of intraoperative antibiotic prophylaxis for preventing post-tympanostomy otorrhea.
- To establish an economic model for physicians to assess intervention costs for patients and institutions.
Main Methods:
- An analytical observational study utilizing literature review and purchasing records.
- Break-even analysis to determine the required absolute risk reduction (ARR) and infection rate for cost-effectiveness.
- Comparison of intraoperative ofloxacin and ciprofloxacin-dexamethasone with various outpatient treatments.
Main Results:
- Ofloxacin prophylaxis was cost-effective against ciprofloxacin-dexamethasone ophthalmic and otic outpatient treatments (ARRs of 0.08 and 0.01, respectively).
- Ciprofloxacin-dexamethasone prophylaxis was cost-effective only when used with ciprofloxacin-dexamethasone otic outpatient treatment (ARR of 0.09).
- Neither prophylactic agent was cost-effective when paired with ofloxacin outpatient treatment.
Conclusions:
- Intraoperative prophylaxis demonstrates potential cost-effectiveness in preventing post-tympanostomy otorrhea.
- The developed economic model can guide clinical decision-making regarding prophylactic interventions.
Objective:
Tympanostomy is the most common pediatric ambulatory surgery. Post-tympanostomy otorrhea is a prevalent complication leading to high costs to patients for treatment. The cost-effectiveness of intraoperative prophylaxis for both patient and institution has not been examined.
Study Design:
An analytical observational study of data collected from the literature and purchasing records.
Methods:
A break-even analysis was performed to determine the required absolute risk reduction (ARR) and final infection rate in post-tympanostomy otorrhea to make intraoperative prophylaxis using ofloxacin and ciprofloxacin dexamethasone otic version cost effective with the following outpatient treatments: ofloxacin, ciprofloxacin-dexamethasone ophthalmic version, and ciprofloxacin-dexamethasone otic version. Absolute risk reduction is a statistic used to express the difference in risk between a treatment and control. The conservative initial infection rate used was 10%.
Results:
Ofloxacin intraoperative prophylaxis was not cost effective when prescribing ofloxacin outpatient treatment with an ARR of 0.20. Ofloxacin intraoperative prophylaxis was cost-effective with an ARR of 0.08 for ciprofloxacin-dexamethasone ophthalmic version outpatient treatment. Ofloxacin intraoperative prophylaxis was cost-effective for ciprofloxacin-dexamethasone otic version outpatient treatment with an ARR of 0.01.Ciprofloxacin-dexamethasone intraoperative prophylaxis was not cost-effective when prescribing ofloxacin outpatient treatment with an ARR of 1.52. Ciprofloxacin-dexamethasone intraoperative prophylaxis was not cost-effective when prescribing ciprofloxacin-dexamethasone ophthalmic version outpatient treatment with an ARR of 0.60. Ciprofloxacin-dexamethasone intraoperative prophylaxis was cost effective when prescribing ciprofloxacin-dexamethasone otic version outpatient treatment with an ARR of 0.09.
Conclusion:
Intraoperative prophylaxis can be cost effective for preventing post-tympanostomy otorrhea. Physicians can use this economic model to determine the cost-effectiveness of these interventions for their patients and institutions.
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