title: A cost threshold analysis of ciprofloxacin-dexamethasone versus ofloxacin for acute otitis media in pediatric patients with tympanostomy tubes.
abstract: OBJECTIVE
  The aim of this study was to determine the cost-effectiveness hreshold of a ciprofloxacin 0.3% and dexamethasone 0.1% (CD) otic suspension relative to olfloxacin otic solution (OFX) for the treatment of acute otitis media in pediatric patients with tympanostomy tubes (AOMT).
  
  
  METHODS
  This study used a decision-analytic model to simulate the costs and consequences of the ototopical treatment of AOMT. The AOMT model consisted of 3 tiers of antimicrobial therapy. Each successive tier represented the repeat treatment of clinical failures from the preceding tier. Patients were modeled for treatment until cured or until third-tier therapy was complete, at which time patients were considered cured. First-tier therapy modeled a comparison of CD and OFX using efficacy rates taken from a randomized clinical trial with a population of 599 patients. Second-tier therapy modeled the use of amoxicillin and clavulanic acid using an efficacy rate taken from the medical literature. Third-tier therapy was modeled as being pathogen specific and could follow 1 of 3 possible clinical pathways: (1) PO fluconazole, (2) IM ceftriaxone, or (3) IV antibiotics administered in a hospital setting. Third-tier therapeutic pathway probabilities were based on the microbiologic spectrum of the treatment failures from the clinical trial. Cost information (in year-2003 US dollars) was taken from accepted cost reference sources and presented from the perspective of a third-party payer. The economic outcome of interest was the cost-effectiveness threshold of CD relative to OFX.
  
  
  RESULTS
  Given the model parameters, CD had a cost-effectiveness threshold value of 4.5 times the wholesale acquisition cost of OFX. Based on actual cost, first-tier CD therapy was more cost-effective than OFX up to a threshold price of US 152.64 dollars.
  
  
  CONCLUSIONS
  In this decision-analytic model, CD was more cost-effective than OFX for AOMT therapy in pediatric patients up to a threshold price of 4.5 times the price of OFX.
authors.affiliation: Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Roland
authors.forename: Allison
authors.initials: A
authors.lastname: Pontius
authors.forename: G
authors.initials: G
authors.lastname: Michael Wall
authors.forename: Curtis R
authors.initials: CR
authors.lastname: Waycaster
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D002170:Canada; D002648:Child; D002939:Ciprofloxacin / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003907:Dexamethasone / Q000191:economics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008876:Middle Ear Ventilation / Q000191:economics*; D015242:Ofloxacin / Q000191:economics / Q000627:therapeutic use*; D010033:Otitis Media / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D003907:Dexamethasone; D015242:Ofloxacin