A Cost-Utility Analysis of 5 Strategies for the Management of Acute Otitis Media in Children.

Abstract

OBJECTIVE:

To assess whether antimicrobial therapy in young children with acute otitis media reduces time to resolution of symptoms, overall symptom burden, and persistence of otoscopic evidence of infection. We used a cost-utility model to evaluate whether immediate antimicrobial treatment seems to be worthwhile, and if so, which antimicrobial agent is most cost effective.

STUDY DESIGN:

We compared the cost per quality-adjusted life-day of 5 treatment regimens in children younger than 2 years of age with acute otitis media: immediate amoxicillin/clavulanate, immediate amoxicillin, immediate cefdinir, watchful waiting, and delayed prescription (DP) for antibiotic.

RESULTS:

The 5 treatment regimens, listed in order from least effective to most effective were DP, watchful waiting, immediate cefdinir, immediate amoxicillin, and immediate amoxicillin/clavulanate. Listed in order from least costly to most costly, the regimens were DP, immediate amoxicillin, watchful waiting, immediate amoxicillin/clavulanate, and immediate cefdinir. The incremental cost-utility ratio of immediate amoxicillin compared with DP was $101.07 per quality-adjusted life-day gained. The incremental cost-utility ratio of immediate amoxicillin/clavulanate compared with amoxicillin was $2331.28 per quality-adjusted life-day gained.

CONCLUSIONS:

In children younger than 2 years of age with acute otitis media and no recent antibiotic exposure, immediate amoxicillin seems to be the most cost-effective initial treatment.

• Authors: Nader Shaikh, Emily E Dando, Mark L Dunleavy, Dorothy L Curran, Judith M Martin, Alejandro Hoberman, Kenneth J Smith
• Journal: The Journal of pediatrics (J Pediatr) Vol. 189 Pg. 54-60.e3 (10 2017) ISSN: 1097-6833 [Electronic] United States
• PMID: 28666536 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Infective Agents

Topics

• Acute Disease
• Anti-Infective Agents (economics, therapeutic use)
• Child
• Child, Preschool
• Cost-Benefit Analysis
• Humans
• Infant
• Otitis Media (drug therapy, economics)
• Treatment Outcome