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Research ArticleOriginal Research

Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media

Andrew S. Coco
The Annals of Family Medicine January 2007, 5 (1) 29-38; DOI: https://doi.org/10.1370/afm.626
Andrew S. Coco
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Abstract

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.

  • Acute otitis media
  • cost-effectiveness analysis
  • decision analysis
  • health care use
  • disease management
  • children
  • antibiotics
  • watchful waiting
  • Received for publication January 30, 2006.
  • Revision received May 3, 2006.
  • Accepted for publication May 22, 2006.
  • © 2007 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 5 (1)
The Annals of Family Medicine: 5 (1)
Vol. 5, Issue 1
1 Jan 2007
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Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media
Andrew S. Coco
The Annals of Family Medicine Jan 2007, 5 (1) 29-38; DOI: 10.1370/afm.626

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Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media
Andrew S. Coco
The Annals of Family Medicine Jan 2007, 5 (1) 29-38; DOI: 10.1370/afm.626
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