title: Payment analysis of two diagnosis and management approaches of acute otitis media.
abstract: We determined the cost of care for 2 diagnosis and management approaches for acute otitis media (AOM) among children 6 to 30 months old. A case-control design was used. Cases included 208 children diagnosed with AOM based on a bulging tympanic membrane (TM) and treated with amoxicillin/clavulanate. Controls (5:1 ratio) included 1020 children with AOM diagnosed not requiring bulging of the TM and treated with amoxicillin. Fewer cases (49%) than controls (69%) were diagnosed with AOM (P < .001), fewer were diagnosed with recurrent AOM or AOM treatment failure (0.34 vs 1.6/child; P < .0001), and fewer had insertion of tympanostomy tubes (6.3% vs 14.8%) due to recurrent AOM (P < .0001). The combined direct payments and indirect costs for management of AOM were $539/case versus $1,023/control. Using Rochester NY payments generalized to the US birth cohort, this case diagnosis and treatment strategy could save $1.008 billion per year.
authors.affiliation: Legacy Pediatrics, Rochester, NY, USA.
authors.forename: Janet R
authors.initials: JR
authors.lastname: Casey
authors.affiliation: Rochester General Hospital Research Institute, Rochester, NY, USA Michael.Pichichero@rochestergeneral.org.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Pichichero
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008876:Middle Ear Ventilation; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000628:therapy; D011320:Primary Health Care / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin
keywords: acute otitis media; antibiotics; guidelines; payment analysis; tympanostomy tubes