Cost-Effectiveness of Management Strategies in Recurrent Acute Otitis Media - 05/05/23
Abstract |
Objective |
To evaluate the cost-effectiveness of tympanostomy tube placementvs nonsurgical medical management, with the option of tympanostomy tube placement in the event of treatment failure, in children with recurrent acute otitis media (AOM).
Study design |
A Markov decision model compared management strategies in children ages 6-35 months, using patient-level data from a recently completed, multicenter, randomized clinical trial of tympanostomy tube placement vs medical management. The model ran over a 2-year time horizon using a societal perspective. Probabilities, including risk of AOM symptoms, were derived from prospectively collected patient diaries. Costs and quality-of-life measures were derived from the literature. We performed one-way and probabilistic sensitivity analyses, and secondary analyses in predetermined low- and high-risk subgroups. The primary outcome was incremental cost per quality-adjusted life-year gained.
Results |
Tympanostomy tubes cost $989 more per child than medical management. Children managed with tympanostomy tubes gained 0.69 more quality-adjusted life-days than children managed medically, corresponding to $520 855 per quality-adjusted life-year gained. Results were sensitive to the costs of oral antibiotics, missed work, special childcare, the societal cost of antibiotic resistance, and the quality of life associated with AOM. In probabilistic sensitivity analyses, medical management was favored in 66% of model iterations at a willingness-to-pay threshold of $100 000/quality-adjusted life-year. Medical management was preferred in secondary analyses of low- and high-risk subgroups.
Conclusions |
For young children with recurrent AOM, the additional cost associated with tympanostomy tube placement outweighs the small improvement in quality of life. Medical management for these children is an economically reasonable strategy.
Trial registration |
ClinicalTrials.gov number, NCT02567825.
Le texte complet de cet article est disponible en PDF.Keywords : acute otitis media, economic analysis, tympanostomy tubes
Abbreviations: : AOM, ICER, QALD, QALY, US
Plan
A.H. reports owning stock in Kaizen Bioscience, holding patent 9, 636, 007 B2 on a method and apparatus for aiding diagnosis of otitis media by classifying tympanic-membrane images, and holding patent 9, 987, 257 B2 on pediatric oral-suspension formulation of amoxicillin–clavulanate potassium and the method for use, licensed to Kaizen Bioscience. The other authors declare no conflicts of interest. |
Vol 256
P. 11 - mai 2023 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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