An economic evaluation of two ototopical treatments for acute otitis media in tympanostomy tube patients.
OBJECTIVE
The goal of this research was to determine the cost-effectiveness of ciprofloxacin 0.3%/dexamethasone 0.1% (CD) otic suspension versus ofloxacin 0.3% otic solution (OFX) for treatment of acute otitis media in tympanostomy tube patients.


METHODS
A decision-analytic model was used to emulate the ototopical treatment of acute otitis media in patients with tympanostomy tubes. The economic outcome was the cost per otorrhea-free day (OFD) achieved per episode of care. Three tiers of antimicrobial therapy were modeled, with each successive tier representing the retreatment of clinical failures from the preceding tier. First-tier therapy compared CD and OFX using outcome measures obtained from a randomized clinical trial (n = 599). Second-tier therapy modeled the use of amoxicillin/clavulanate (ACA) using outcome measures obtained from a physician survey and medical literature. Third-tier therapy was modeled as pathogen-specific and curative. It could follow one of three pathways: 1) intramuscular ceftriaxone; 2) oral fluconazole; or 3) hospitalization for intravenous antibiotics. Third-tier outcomes were based on a physician survey. Cost data were obtained from standard references and presented from a payer perspective.


RESULTS
The expected therapeutic costs were 249.40 dollars for the CD pathway and 265.44 dollars for the OFX pathway. The estimated number of OFDs per episode of care was 25.88 for the CD pathway and 23.86 for the OFX pathway. The cost-effectiveness ratios for CD and OFX therapies were 9.64 dollars and 11.13 dollars per OFD, respectively.


CONCLUSIONS
CD is both more effective and less costly than OFX for the treatment of acute otitis media in patients with tympanostomy tubes.
Roland
Peter S
PS
Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Waycaster
Curtis R
CR
Wall
G Michael
GM
Glass
Jeffrey D
JD
D000208:Acute Disease; D000287:Administration, Topical; D000465:Algorithms; D000891:Anti-Infective Agents, Local / Q000145:classification / Q000191:economics* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003907:Dexamethasone / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D017050:Episode of Care; D006801:Humans; D008876:Middle Ear Ventilation; D017059:Models, Econometric; D015242:Ofloxacin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D010033:Otitis Media / Q000188:drug therapy* / Q000191:economics; D017063:Outcome Assessment, Health Care / Q000191:economics*; D013997:Time Factors
D000891:Anti-Infective Agents, Local; D002939:Ciprofloxacin; D003907:Dexamethasone; D015242:Ofloxacin