Direct Expenditures Related to Otitis Media Diagnoses: Extrapolations From a Pediatric Medicaid Cohort

• Published in: Pediatrics (Evanston) 2000-06, Vol.105 (6), p.e72-e72
• Main Authors: Bondy, Jessica, Berman, Stephen, Glazner, Judith, Lezotte, Dennis
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Child; Child, Preschool; Colorado; Fee-for-Service Plans; Female; Health Expenditures; Humans; Infant; Insurance, Health - economics; Linear Models; Male; Medicaid - economics; Office Visits - economics; Otitis Media - economics; Otitis Media - ethnology; Otitis Media - therapy; Pediatrics; Practice Guidelines as Topic; Sex Factors; Statistics, Nonparametric; United States
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.105.6.e72

Treatment of otitis media in children is associated with substantial expenditures because of its high frequency during childhood. Vaccines against respiratory pathogens causing otitis media are now being developed. Information about otitis media-related medical expenditures will be needed to determine the cost-effectiveness of these preventive interventions. This study used utilization data from claims to impute otitis media-related expenditures for medical visits, pharmaceuticals, and surgical procedures for 87 057 children 13 years of age and younger who were continuously enrolled in Colorado's fee-for-service Medicaid program during 1992. International Classification of Disease, Ninth Revision diagnostic codes were used to identify visits for otitis media. An antibiotic was considered to have been prescribed to treat otitis media if it was dispensed up to 24 hours before or within 48 hours after a physician encounter showing a diagnosis of otitis media. All tympanostomies, mastoidectomies, and adenoidectomies were assumed to be related to otitis media. Expenditures were imputed from utilization using a Medicaid fee schedule. National expenditures for 1992 to treat otitis media were extrapolated from Colorado's Medicaid data. We adjusted for differences between Colorado and the United States as a whole in terms of price, number, and intensity of services; for differences in reimbursement rates by service between Medicaid and private insurance; and for differences in utilization between Medicaid enrollees and the uninsured. To provide a more current expression of medical expenditures for otitis media, we inflated the 1992 expenditure estimates to 1998 dollars using the Consumer Price Index published by the US Bureau of Labor Statistics. Twenty-eight percent of children experienced at least 1 episode of diagnosed otitis media. The proportion of children with a diagnosis of otitis media was highest (42%-60%) in the 7-month to 36-month age range. The proportion was also higher among white (34.5%) and Hispanic (25.3%) children than among black children (18.5%), as well as among rural (34.5%) compared with urban children (27.2%). Children 19 to 24 months of age incurred the highest total annual expenditures per child with otitis media ($239.68). Expenditures for drugs, visits, and procedures were all highest for this group. The per-patient cost to Medicaid was greater for visits than for drugs or procedures across all age groups. Total per-patient expenditures