PT  - JOURNAL ARTICLE
AU  - Andrew S. Coco
TI  - Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media
AID  - 10.1370/afm.626
DP  - 2007 Jan 01
TA  - The Annals of Family Medicine
PG  - 29--38
VI  - 5
IP  - 1
4099  - http://www.annfammed.org/content/5/1/29.short
4100  - http://www.annfammed.org/content/5/1/29.full
SO  - Ann Fam Med2007 Jan 01; 5
AB  - 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.