Bisonni R S, Lawler F H, Pierce L
Department of Family Medicine, Oklahoma University Health Sciences Center, Oklahoma City.
Fam Pract Res J. 1991 Dec;11(4):371-8.
Using a cost-utility analysis, the effectiveness of tympanostomy tubes was compared to that of antibiotic chemoprophylaxis in young patients with recurrent otitis media. The tympanostomy approach (T-tubes) consisted of placement of a polyethylene grommet in the tympanic membrane, with systemic and local antibiotics administered for one week. The chemoprophylaxis approach consisted of antibiotics in full doses for seven to ten days, followed by continuous antibiotic chemoprophylaxis for six months. Because the T-tube strategy under the model assumptions was more expensive ($396.44 vs $281.30) and yielded slightly less benefit (net utility of .9325 vs. .9476 for initial antibiotic therapy), the chemoprophylaxis option was preferred. We conclude that the initial treatment for recurrent otitis media should consist of acute antibiotics followed by chemoprophylaxis, with T-tubes reserved for treatment failure. Extreme changes in the baseline probabilities of cure or recurrence with antibiotic therapy or in the cost of antibiotic therapy or tympanostomy surgery were required to alter this conclusion. Varying therapy preference (utility) values did not materially alter the conclusions.
采用成本效用分析方法，对复发性中耳炎年轻患者中鼓膜置管术与抗生素预防性化疗的有效性进行了比较。鼓膜置管术（T型管）包括在鼓膜中放置一个聚乙烯通气管，并给予全身和局部抗生素治疗一周。预防性化疗方法包括给予全剂量抗生素7至10天，随后持续进行6个月的抗生素预防性化疗。由于在模型假设下，T型管策略成本更高（396.44美元对281.30美元）且获益略少（初始抗生素治疗的净效用为0.9325对0.9476），因此更倾向于预防性化疗方案。我们得出结论，复发性中耳炎的初始治疗应包括急性抗生素治疗，随后进行预防性化疗，T型管则留作治疗失败时使用。需要抗生素治疗的治愈或复发基线概率、抗生素治疗成本或鼓膜置管手术成本发生极端变化，才能改变这一结论。不同的治疗偏好（效用）值并未实质性改变结论。
