Cost-effectiveness of treatment of acute otorrhea in children with tympanostomy tubes

• Published in: Pediatrics (Evanston) 2015-05, Vol.135 (5), p.e1182-e1189
• Main Authors: van Dongen, Thijs M A, Schilder, Anne G M, Venekamp, Roderick P, de Wit, G Ardine, van der Heijden, Geert J M G
• Format: Article
• Language: English
• Subjects: Acute Disease; Anti-Bacterial Agents - economics; Anti-Bacterial Agents - therapeutic use; Antibiotics; Body Fluids; Care and treatment; Child, Preschool; Children & youth; Cost-Benefit Analysis; Ear; Ear diseases; Ear Diseases - drug therapy; Ear Diseases - economics; Effectiveness; Epidemiology; Failure; Glucocorticoids - economics; Glucocorticoids - therapeutic use; Humans; Middle ear ventilation; Middle Ear Ventilation - instrumentation; Otorrhea; Pediatrics; Postoperative Complications - drug therapy; Postoperative Complications - economics; Secretions
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2014-3141

Acute otorrhea is a common problem in children with tympanostomy tubes. We recently demonstrated that treatment with antibiotic-glucocorticoid eardrops is clinically superior to oral antibiotics and initial observation. The aim of this study was to assess the cost-effectiveness of these three common treatment strategies for this condition. We performed an open-label pragmatic trial in which 230 children with acute uncomplicated tympanostomy-tube otorrhea were randomly allocated to receive 1 of 3 treatments: hydrocortisone-bacitracin-colistin eardrops, oral amoxicillin-clavulanate suspension, and initial observation (no assigned medication prescription to fill). Parents kept a daily diary capturing ear-related symptoms, health care resource use, and non-health care costs for 6 months. At 2 weeks and 6 months, the study doctor visited the children at home performing otoscopy. Using a societal perspective, treatment failure (otoscopic presence of otorrhea at 2 weeks) and number of days with otorrhea as reported in the daily diary were balanced against the costs. Antibiotic-glucocorticoid eardrops were clinically superior to oral antibiotics and initial observation both at 2 weeks and 6 months. At 2 weeks, mean total cost per patient was US$42.43 for antibiotic-glucocorticoid eardrops, US$70.60 for oral antibiotics, and US$82.03 for initial observation. At 6 months, mean total cost per patient was US$368.20, US$420.73, and US$640.44, respectively. Because of the dominance of eardrops, calculating incremental cost-effectiveness ratios was redundant. Antibiotic-glucocorticoid eardrops are clinically superior and cost less than oral antibiotics and initial observation in children with tympanostomy tubes who develop otorrhea.