A cost threshold analysis of ciprofloxacin-dexamethasone versus ofloxacin for acute otitis media in pediatric patients with tympanostomy tubes

Peter S. Roland, Allison Pontius, G. Michael Wall, Curtis R. Waycaster

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: The aim of this study was to determine the cost-effectiveness hreshold of a ciprofloxacin 0.3% and dexamethasone 0.1% (CD) otic suspension relative to olfloxacin otic solution (OFX) for the treatment of acute otitis media in pediatric patients with tympanostomy tubes (AOMT). Methods: This study used a decision-analytic model to simulate the costs and consequences of the ototopical treatment of AOMT. The AOMT model consisted of 3 tierse of antimicrobial therapy. Each successive tier represented the repeat treatment of clinical failures from the preceding tier. Patients were modeled for treatment until cured or until third-tier therapy was complete, at which time patients were considered cured. First-tier therapy modeled a comparison of CD and OFX using efficacy rates taken from a randomized clinical trial with a population of 599 patients. Second-tier therapy modeled the use of amoxicillin and clavulanic acid using an efficacy rate taken from the medical literature. Third-tier therapy was modeled as being pathogen specific and could follow 1 of 3 possible clinical pathways: (1) PO fluconazole, (2) IM ceftriaxone, or (3) IV antibiotics administered in a hospital setting. Third-tier therapeutic pathway probabilities were based on the microbiologic spectrum of the treatment failures from the clinical trial. Cost information (in year-2003 US dollars) was taken from accepted cost reference sources and presented from the perspective of a third-party payer. The economic outcome of interest was the cost-effectiveness threshold of CD relative to OFX. Results: Given the model parameters, CD had a cost-effectiveness threshold value of 4.5 times the wholesale acquisition cost of OFX. Based on actual cost, first-tier CD therapy was more cost-effective than OFX up to a threshold price of $152.64. Conclusion: In this decision-analytic model, CD was more cost-effective than OFX for AOMT therapy in pediatric patients up to a threshold price of 4.5 times the price of OFX.

Original languageEnglish (US)
Pages (from-to)1168-1178
Number of pages11
JournalClinical Therapeutics
Volume26
Issue number7
DOIs
StatePublished - Jul 2004

Fingerprint

Middle Ear Ventilation
Ofloxacin
Otitis Media
Ciprofloxacin
Dexamethasone
Pediatrics
Costs and Cost Analysis
Therapeutics
Cost-Benefit Analysis
Treatment Failure
Ear
Health Insurance Reimbursement
Amoxicillin-Potassium Clavulanate Combination
Critical Pathways
Ceftriaxone
Fluconazole
Suspensions
Randomized Controlled Trials

Keywords

  • acute otitis media
  • ciprofloxacin
  • cost-effectiveness
  • dexamethasone
  • ofloxacin
  • otorrhea
  • threshold analysis
  • tympanostomy tubes

ASJC Scopus subject areas

  • Pharmacology

Cite this

A cost threshold analysis of ciprofloxacin-dexamethasone versus ofloxacin for acute otitis media in pediatric patients with tympanostomy tubes. / Roland, Peter S.; Pontius, Allison; Michael Wall, G.; Waycaster, Curtis R.

In: Clinical Therapeutics, Vol. 26, No. 7, 07.2004, p. 1168-1178.

Research output: Contribution to journalArticle

Roland, Peter S. ; Pontius, Allison ; Michael Wall, G. ; Waycaster, Curtis R. / A cost threshold analysis of ciprofloxacin-dexamethasone versus ofloxacin for acute otitis media in pediatric patients with tympanostomy tubes. In: Clinical Therapeutics. 2004 ; Vol. 26, No. 7. pp. 1168-1178.
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AB - Objective: The aim of this study was to determine the cost-effectiveness hreshold of a ciprofloxacin 0.3% and dexamethasone 0.1% (CD) otic suspension relative to olfloxacin otic solution (OFX) for the treatment of acute otitis media in pediatric patients with tympanostomy tubes (AOMT). Methods: This study used a decision-analytic model to simulate the costs and consequences of the ototopical treatment of AOMT. The AOMT model consisted of 3 tierse of antimicrobial therapy. Each successive tier represented the repeat treatment of clinical failures from the preceding tier. Patients were modeled for treatment until cured or until third-tier therapy was complete, at which time patients were considered cured. First-tier therapy modeled a comparison of CD and OFX using efficacy rates taken from a randomized clinical trial with a population of 599 patients. Second-tier therapy modeled the use of amoxicillin and clavulanic acid using an efficacy rate taken from the medical literature. Third-tier therapy was modeled as being pathogen specific and could follow 1 of 3 possible clinical pathways: (1) PO fluconazole, (2) IM ceftriaxone, or (3) IV antibiotics administered in a hospital setting. Third-tier therapeutic pathway probabilities were based on the microbiologic spectrum of the treatment failures from the clinical trial. Cost information (in year-2003 US dollars) was taken from accepted cost reference sources and presented from the perspective of a third-party payer. The economic outcome of interest was the cost-effectiveness threshold of CD relative to OFX. Results: Given the model parameters, CD had a cost-effectiveness threshold value of 4.5 times the wholesale acquisition cost of OFX. Based on actual cost, first-tier CD therapy was more cost-effective than OFX up to a threshold price of $152.64. Conclusion: In this decision-analytic model, CD was more cost-effective than OFX for AOMT therapy in pediatric patients up to a threshold price of 4.5 times the price of OFX.

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KW - dexamethasone

KW - ofloxacin

KW - otorrhea

KW - threshold analysis

KW - tympanostomy tubes

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