Amoxicillin Most Cost-effective for Toddlers With Acute Otitis Media

Abstract

Research Article| January 01 2018 Amoxicillin Most Cost-effective for Toddlers With Acute Otitis Media AAP Grand Rounds (2018) 39 (1): 3. https://doi.org/10.1542/gr.39-1-3 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Amoxicillin Most Cost-effective for Toddlers With Acute Otitis Media. AAP Grand Rounds January 2018; 39 (1): 3. https://doi.org/10.1542/gr.39-1-3 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: amoxicillin, cost effectiveness, otitis media, acute, toddler Source: Shaikh N, Dando EE, Dunleavy ML, et al. A cost-utility analysis of 5 strategies for the management of acute otitis media in children. J Pediatr. 2017; 189: 54– 60.e3; doi: https://doi.org/10.1016/j.jpeds.2017.05.047Google Scholar Investigators from multiple institutions conducted a cost-utility analysis to assess whether immediate antibiotic treatment for acute otitis media (AOM) among children <2 years old is preferable over delayed antibiotic approaches and, if so, which antibiotic is the most cost-effective. Five treatment options were evaluated: immediate amoxicillin, immediate amoxicillin/clavulanate, immediate cefdinir, delayed prescription (DP, in which parents are given a prescription for an antibiotic but are told to not fill it unless their child’s symptoms don’t improve within 48 hours), and watchful waiting (WW, where no prescription is given at initial visit for AOM). With each approach, the probabilities of the following outcomes were estimated based on the results of previously published studies: early (within 7 days of diagnosis) clinical success, improved symptoms, persistent symptoms, early clinical failure, recurrent AOM, mastoiditis, diarrhea, diaper rash, and body rash. The investigators used both direct medical costs and indirect expense estimates to calculate the costs of each of the 5 management options. In addition, they determined the quality adjusted life days (QALD) over a 30-day period for each child in the hypothetical cohort, where a day of perfect health was calculated as 1.0 QALD and a day of less than perfect health due to persistent symptoms and/or adverse events related to antibiotic use (eg, diarrhea) was assessed as <1.0. Finally, to determine whether use of antibiotics is “worth it,” the investigators used previous research suggesting that societal willingness to pay for 1 QALD gained was $2741 and computed the incremental cost-effectiveness ratio (ICER), defined as the extra cost of a particular management plan compared to the next less expensive option divided by the number of QALD gained. Overall costs of DP were the lowest of the 5 treatment options, followed by immediate amoxicillin, WW, and immediate amoxicillin/clavulanate; immediate cefdinir was associated with the highest costs. Each of the antibiotic options yielded slightly more QALDs in a 30-day period than either DP or WW. Compared to the DP treatment option, the ICER of immediate amoxicillin for 1 QALD gained was $101; the ICER of immediate amoxicillin/clavulanate compared to immediate amoxicillin was $2,331. The authors conclude that immediate amoxicillin is the most cost-effective treatment for children <2 years old with AOM. Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. AOM is the leading cause of pediatric health care visits and the most common reason pediatricians prescribe antibiotics.2 At >6 million visits per year, it accounts for $4 billion of the health care budget. Despite this, the appropriate therapy remains controversial. For the most part, AOM is a self-limiting disease, with antibiotics reducing symptoms by 1 day.2 Delayed prescription protocols have shown... You do not currently have access to this content.