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Cost-Effectiveness of Management Strategies in Recurrent Acute Otitis Media
Kathleen A Noorbakhsh1, Hui Liu1, Marcia Kurs-Lasky1
1Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA.
Insights
For children with recurrent acute otitis media (AOM), medical management is more cost-effective than tympanostomy tubes. This strategy offers better economic value and is recommended for young children facing recurrent ear infections.
Area of Science:
- Pediatric Otolaryngology
- Health Economics
- Evidence-Based Medicine
Background:
- Recurrent acute otitis media (AOM) significantly impacts children's quality of life and incurs substantial healthcare costs.
- Management strategies for recurrent AOM, including tympanostomy tube insertion and medical management, require rigorous cost-effectiveness evaluation.
Purpose of the Study:
- To compare the cost-effectiveness of tympanostomy tube placement versus initial nonsurgical medical management for recurrent AOM in young children.
- To determine the optimal economic strategy considering quality-adjusted life-years (QALYs) gained and healthcare expenditures.
Main Methods:
- A Markov decision model was developed using patient-level data from a randomized clinical trial.
- The model simulated management strategies over a 2-year horizon from a societal perspective, incorporating costs and quality-of-life data.
- Sensitivity analyses were conducted to assess the robustness of the findings across various parameters and subgroups.
Main Results:
- Tympanostomy tube placement incurred an additional cost of $989 per child compared to medical management.
- While tympanostomy tubes yielded a small gain in quality-adjusted life-days, the incremental cost per QALY gained was substantial ($520,855).
- Medical management was favored in 66% of probabilistic sensitivity analyses and in both low- and high-risk subgroups.
Conclusions:
- For young children with recurrent AOM, the incremental costs of tympanostomy tubes exceed the marginal improvements in quality of life.
- Nonsurgical medical management represents an economically reasonable and preferred strategy for this patient population.
- These findings support the use of medical management as a primary, cost-effective approach for recurrent AOM in children.
Objective:
To evaluate the cost-effectiveness of tympanostomy tube placementvs nonsurgical medical management, with the option of tympanostomy tube placement in the event of treatment failure, in children with recurrent acute otitis media (AOM).
Study Design:
A Markov decision model compared management strategies in children ages 6-35 months, using patient-level data from a recently completed, multicenter, randomized clinical trial of tympanostomy tube placement vs medical management. The model ran over a 2-year time horizon using a societal perspective. Probabilities, including risk of AOM symptoms, were derived from prospectively collected patient diaries. Costs and quality-of-life measures were derived from the literature. We performed one-way and probabilistic sensitivity analyses, and secondary analyses in predetermined low- and high-risk subgroups. The primary outcome was incremental cost per quality-adjusted life-year gained.
Results:
Tympanostomy tubes cost $989 more per child than medical management. Children managed with tympanostomy tubes gained 0.69 more quality-adjusted life-days than children managed medically, corresponding to $520 855 per quality-adjusted life-year gained. Results were sensitive to the costs of oral antibiotics, missed work, special childcare, the societal cost of antibiotic resistance, and the quality of life associated with AOM. In probabilistic sensitivity analyses, medical management was favored in 66% of model iterations at a willingness-to-pay threshold of $100 000/quality-adjusted life-year. Medical management was preferred in secondary analyses of low- and high-risk subgroups.
Conclusions:
For young children with recurrent AOM, the additional cost associated with tympanostomy tube placement outweighs the small improvement in quality of life. Medical management for these children is an economically reasonable strategy.
Trial Registration:
ClinicalTrials.gov number, NCT02567825.
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