RT Journal Article
SR Electronic
T1 Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 29
OP 38
DO 10.1370/afm.626
VO 5
IS 1
A1 Coco, Andrew S.
YR 2007
UL http://www.annfammed.org/content/5/1/29.abstract
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.