Valuing reduced antibiotic use for pediatric acute otitis media.
OBJECTIVE
The 2004 American Academy of Pediatrics acute otitis media guidelines urge parents to weigh the benefits of reduced antibiotic use, adverse drug events, and future resistance versus risks of extra costs and sick days resulting from guideline use. The value of decreased antibiotic resistance has not been quantified. The objective was to perform cost-utility analysis, estimating the resistance value of implementing the guidelines for acute otitis media treatment for children <2 years of age. Outcomes were described with a common denominator and the value of avoiding resistance was estimated using a parental perspective.


METHODS
Decision analysis results were used for outcome probabilities. Published utilities were used to describe outcomes in quality-adjusted life-day units. The minimum resistance benefit value, where the benefits of the American Academy of Pediatrics guidelines would at least balance their costs, was defined as the guidelines' incremental costs minus their other benefits.


RESULTS
For a child 2 to <6 months of age presenting to a primary care physician with possible otitis media, parents would need to value the resistance benefit at 0.77 quality-adjusted life-days per antibiotic prescription avoided for the guidelines' benefits to balance their costs. For the 6- to <24-month-old group, results were 0.67 quality-adjusted life-days per prescription avoided. Results were sensitive to the dollar cost utility; when willingness to pay ranged from $20,000 to $200,000 per quality-adjusted life-year, results ranged from 0.36 and 0.30 quality-adjusted life-days up to 4.10 and 3.57 quality-adjusted life-days for the 2- to <6-month-old and 6- to <24-month-old groups, respectively. Costs were driven by missed parent work days.


CONCLUSIONS
From a societal perspective, trading 0.30 to 4 quality-adjusted life-days to avoid 1 antibiotic course might be desirable; from a parental perspective, this may not be as desirable. Parent demand for antibiotics may be rational when driven by the value of parent time. Other approaches that have the potential to reduce antibiotic use, such as wider use of influenza vaccine and improved rapid viral diagnostic techniques, might be more successful.
Meropol
Sharon B
SB
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, Room 108, Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104, USA. meropols@mail.med.upenn.edu
D000047:Academies and Institutes; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D010372:Pediatrics / Q000592:standards; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States
D000900:Anti-Bacterial Agents