HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) In Brief TRACK Discussion: Submit a Comment TRACK Discussion: View Comments Alert me when this article is cited Alert me when TRACK Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Coco, A. S. Search for Related Content PubMed PubMed Citation Articles by Coco, A. S. Related Collections Acute illness Children's health Quantitative methods Health services

Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media

Von Hess Healthcare Research Center, Family and Community Medicine, Lancaster General Hospital, Lancaster, Pa

CORRESPONDING AUTHOR: Andrew S. Coco, MD, MS, Von Hess Healthcare Research Center, Family and Community Medicine, Lancaster General Hospital, 555 N Duke St, Lancaster, PA 17604-3555, ascoco{at}lancastergeneral.org

PURPOSE This study evaluated the costs and utility of observation and routine antibiotic treatment options for children with acute otitis media.

METHODS The cost-effectiveness analysis was performed among children aged 6 months to 12 years seen in primary care offices. The interventions studied were watchful waiting as practiced in the Netherlands, delayed prescription, 5 days of amoxicillin, and 7 to 10 days of amoxicillin. The main outcome measure was cost per quality-adjusted life-year (QALY).

RESULTS In the base case analysis, delayed prescription was the least costly option and 7 to 10 days of amoxicillin was the most effective. The incremental cost utility ratio (ICUR) of 7 to 10 days of amoxicillin compared with delayed prescription was $56,000 per QALY gained. Watchful waiting and 5 days of amoxicillin were inferior options. The results were sensitive to the rate of nonattendance in the delayed prescription strategy: when the rate was less than 23%, watchful waiting was the least costly option and delayed prescription was an inferior option. Probabilistic sensitivity analysis, in which all model variables were simultaneously varied, showed with 95% certainty that compared with delayed prescription, 7 to 10 days of amoxicillin had a 61% probability of having an ICUR of greater than $50,000 per QALY gained, and watchful waiting had a 23% probability of having an ICUR of less than $50,000 per QALY gained.

CONCLUSIONS Economically, an approach to the treatment of acute otitis media with either an initial period of observation or routine treatment with amoxicillin is reasonable.

Key Words: Acute otitis media • cost-effectiveness analysis • decision analysis • health care use • disease management • children • antibiotics • watchful waiting

This article has been cited by other articles:

				S. B. Meropol, H. A. Glick, and D. A. Asch Age Inconsistency in the American Academy of Pediatrics Guidelines for Acute Otitis Media Pediatrics, April 1, 2008; 121(4): 657 - 668. [Abstract] [Full Text] [PDF]

				K. C. Stange On TRACK: Intended and Unintended Consequences of Direct-to-Consumer Drug Marketing Ann. Fam. Med, March 1, 2007; 5(2): 175 - 178. [Full Text] [PDF]

				K. C. Stange In This Issue: Doctor-Patient and Drug Company-Patient Communication Ann. Fam. Med, January 1, 2007; 5(1): 2 - 4. [Full Text] [PDF]

TRACK Comments: