Cost-effectiveness of implementing national guidelines in the treatment of acute otitis media in children.
OBJECTIVE
Acute otitis media (AOM) is one of the most common diseases of childhood, representing a major disease burden on the society. New evidence-based guidelines for AOM, focusing on children under 7 years of age, were introduced in Finland in 1999. The aim of this study was to evaluate the cost-effectiveness of implementing those guidelines in Finland.


METHODS
A 5-year prospective trial was conducted in thirty community primary healthcare centers in Finland. All AOM patients between 0 and 6 years of age visiting the study health centers for the first time, for this episode of illness, during 1 week in November 1998 (n = 579) and November 2002 (n = 369) were included in this study. The outcome measure was the percentage of symptom-free patients.


RESULTS
The mean direct cost of an AOM episode per patient stayed almost the same after implementing the guidelines, euro152 in 1998 and euro150 in 2002. After implementing the guidelines, the percentage of symptom-free patients was 10 percentage points higher than before the guidelines. The treatment after the implementation of the guidelines, thus, was a dominant strategy.


CONCLUSIONS
Implementing the guidelines to the treatment of AOM in children was associated with extra health benefits at slightly lower direct costs and, thus, is a dominant strategy. The focus of this study was on the short-term effects of the treatment; including long-term effects in the analysis might affect the results.
Koskinen
Hanna
H
Social Insurance Institution and National Research and Development Centre for Welfare and Health, Helsinki, Finland. hanna.koskinen@kela.fi
Rautakorpi
Ulla-Maija
UM
Sintonen
Harri
H
Honkanen
Pekka
P
Huikko
Solja
S
Huovinen
Pentti
P
Klaukka
Timo
T
Palva
Erkki
E
Roine
Risto P
RP
Sarkkinen
Hannu
H
Varonen
Helena
H
Mäkelä
Marjukka
M
D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D005387:Finland; D019983:Guideline Adherence / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D017410:Practice Guidelines as Topic