Parker Devin M, Schang Laura, Wasserman Jared R, Viles Weston D, Bevan Gwyn, Goodman David C
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Department of Management London School of Economics and Political Science, London, United Kingdom; Ludwig-Maximilians-Universität München, München, Germany.
J Pediatr. 2016 Dec;179:178-184.e4. doi: 10.1016/j.jpeds.2016.08.093. Epub 2016 Sep 30.
To compare rates of typmanostomy tube insertions for otitis media with effusion with estimates of need in 2 countries.
This cross-sectional analysis used all-payer claims to calculate rates of tympanostomy tube insertions for insured children ages 2-8 years (2007-2010) across pediatric surgical areas (PSA) for Northern New England (NNE; Maine, Vermont, and New Hampshire) and the English National Health Service Primary Care Trusts (PCT). Rates were compared with expected rates estimated using a Monte Carlo simulation model that integrates clinical guidelines and published probabilities of the incidence and course of otitis media with effusion.
Observed rates of tympanostomy tube placement varied >30-fold across English PCT (N = 150) and >3-fold across NNE PSA (N = 30). At a 25 dB hearing threshold, the overall difference in observed to expected tympanostomy tubes provided was -3.41 per 1000 child-years in England and -0.01 per 1000 child-years in NNE. Observed incidence of insertion was less than expected in 143 of 151 PCT, and was higher than expected in one-half of the PSA. Using a 20 dB hearing threshold, there were fewer tube insertions than expected in all but 2 England and 7 NNE areas. There was an inverse relationship between estimated need and observed tube insertion rates.
Regional variations in observed tympanostomy tube insertion rates are unlikely to be due to differences in need and suggest overall underuse in England and both overuse and underuse in NNE.
比较两个国家中耳积液鼓膜造孔置管率与需求估计值。
本横断面分析使用了所有支付方的索赔数据，以计算2007 - 2010年新英格兰北部（缅因州、佛蒙特州和新罕布什尔州）儿科手术区域（PSA）以及英国国家医疗服务体系初级医疗信托机构（PCT）中2至8岁参保儿童的鼓膜造孔置管率。将这些比率与使用蒙特卡罗模拟模型估计的预期比率进行比较，该模型整合了临床指南以及已发表的中耳积液发病率和病程概率。
在英国的初级医疗信托机构（N = 150）中，观察到的鼓膜造孔置管率差异超过30倍，在新英格兰北部的儿科手术区域（N = 30）中差异超过3倍。在25分贝听力阈值时，英国观察到的与预期的鼓膜造孔置管总体差异为每1000儿童年 - 3.41例，新英格兰北部为每1000儿童年 - 0.01例。在151个初级医疗信托机构中的143个中，观察到的置管发生率低于预期，而在一半的儿科手术区域中高于预期。使用20分贝听力阈值时，除了英国的2个区域和新英格兰北部的7个区域外，所有地区的置管数量均少于预期。估计需求与观察到的置管率之间存在反比关系。
观察到的鼓膜造孔置管率的区域差异不太可能是由于需求差异所致，这表明在英国总体使用不足，在新英格兰北部则存在过度使用和使用不足的情况。
