Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Pediatr. 2023 May;256:11-17.e2. doi: 10.1016/j.jpeds.2022.11.032. Epub 2022 Dec 5.
To evaluate the cost-effectiveness of tympanostomy tube placementvs nonsurgical medical management, with the option of tympanostomy tube placement in the event of treatment failure, in children with recurrent acute otitis media (AOM).
A Markov decision model compared management strategies in children ages 6-35 months, using patient-level data from a recently completed, multicenter, randomized clinical trial of tympanostomy tube placement vs medical management. The model ran over a 2-year time horizon using a societal perspective. Probabilities, including risk of AOM symptoms, were derived from prospectively collected patient diaries. Costs and quality-of-life measures were derived from the literature. We performed one-way and probabilistic sensitivity analyses, and secondary analyses in predetermined low- and high-risk subgroups. The primary outcome was incremental cost per quality-adjusted life-year gained.
Tympanostomy tubes cost $989 more per child than medical management. Children managed with tympanostomy tubes gained 0.69 more quality-adjusted life-days than children managed medically, corresponding to $520 855 per quality-adjusted life-year gained. Results were sensitive to the costs of oral antibiotics, missed work, special childcare, the societal cost of antibiotic resistance, and the quality of life associated with AOM. In probabilistic sensitivity analyses, medical management was favored in 66% of model iterations at a willingness-to-pay threshold of $100 000/quality-adjusted life-year. Medical management was preferred in secondary analyses of low- and high-risk subgroups.
For young children with recurrent AOM, the additional cost associated with tympanostomy tube placement outweighs the small improvement in quality of life. Medical management for these children is an economically reasonable strategy.
ClinicalTrials.gov number, NCT02567825.
评估鼓膜置管与非手术药物治疗（出现治疗失败时行鼓膜置管）对复发性急性中耳炎（AOM）患儿的成本效益。
采用 Markov 决策模型，基于近期完成的一项多中心、鼓膜置管与药物治疗随机临床试验中的患者水平数据，比较 6-35 月龄患儿的管理策略。模型的时间跨度为 2 年，采用社会视角。概率（包括 AOM 症状风险）源自前瞻性收集的患者日记。成本和生活质量指标源自文献。我们进行了单因素和概率敏感性分析，以及预先设定的低危和高危亚组的二次分析。主要结局为增量成本每获得的质量调整生命年。
与药物治疗相比，鼓膜置管每例患儿多花费 989 美元。与药物治疗相比，鼓膜置管患儿的质量调整生命天数增加 0.69 天，即每获得 1 个质量调整生命年的成本为 520855 美元。结果对口服抗生素费用、旷工、特殊儿童保育、抗生素耐药的社会成本以及 AOM 相关生活质量敏感。在概率敏感性分析中，当支付意愿阈值为 100000 美元/质量调整生命年时，药物治疗在模型迭代的 66%中更具优势。在低危和高危亚组的二次分析中，药物治疗更受青睐。
对于复发性 AOM 的幼儿，鼓膜置管相关的额外成本超过了生活质量的微小改善。对这些患儿采用药物治疗是一种具有经济合理性的策略。
ClinicalTrials.gov 编号，NCT02567825。
