The Article in Brief

Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media

Andrew S. Coco, MD, MS

Background In the United States, there are 13.6 million doctor visits per year for children with acute otitis media, or inflammation of the middle ear. In 1995, these visits cost an estimated $2.98 billion. This study compares the costs and effectiveness of 4 approaches to treating children with acute otitis media: (1) watchful waiting (waiting 72 hours to see whether symptoms settle before starting the patient on amoxicillin (an antibiotic)); (2) delayed prescription (parents return to the office for a prescription of amoxicillin if symptoms continue for 48-72 hours); (3) 5 days of amoxicillin treatment; and (4) 7 to 10 days of amoxicillin treatment.

What This Study Found Children with acute otitis media would receive the most benefit by taking routine amoxicillin for 7 to 10 days; however, this approach is costly. Delayed prescription is the least costly option and would have the added benefit of reducing resistance to antibiotics, which occurs with frequent antibiotic use.

Implications

• From an economic perspective, it is reasonable to treat acute otitis media with either an initial period of observation or routine amoxicillin.
• The effectiveness of antibiotics in reducing several hours of symptoms of acute otitis media comes at considerable financial cost.
• This study supports recent guidelines from the American Academy of Pediatrics and American Academy of Family Physicians, which offer the option of observing lower risk children with acute otitis media for 48 to 72 hours, providing relief of symptoms rather than antibiotic treatment.