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Valuing reduced antibiotic use for pediatric acute otitis media.
Pediatrics 2008; 121(4):669-73Ped

Abstract

OBJECTIVE

The 2004 American Academy of Pediatrics acute otitis media guidelines urge parents to weigh the benefits of reduced antibiotic use, adverse drug events, and future resistance versus risks of extra costs and sick days resulting from guideline use. The value of decreased antibiotic resistance has not been quantified. The objective was to perform cost-utility analysis, estimating the resistance value of implementing the guidelines for acute otitis media treatment for children <2 years of age. Outcomes were described with a common denominator and the value of avoiding resistance was estimated using a parental perspective.

METHODS

Decision analysis results were used for outcome probabilities. Published utilities were used to describe outcomes in quality-adjusted life-day units. The minimum resistance benefit value, where the benefits of the American Academy of Pediatrics guidelines would at least balance their costs, was defined as the guidelines' incremental costs minus their other benefits.

RESULTS

For a child 2 to <6 months of age presenting to a primary care physician with possible otitis media, parents would need to value the resistance benefit at 0.77 quality-adjusted life-days per antibiotic prescription avoided for the guidelines' benefits to balance their costs. For the 6- to <24-month-old group, results were 0.67 quality-adjusted life-days per prescription avoided. Results were sensitive to the dollar cost utility; when willingness to pay ranged from $20,000 to $200,000 per quality-adjusted life-year, results ranged from 0.36 and 0.30 quality-adjusted life-days up to 4.10 and 3.57 quality-adjusted life-days for the 2- to <6-month-old and 6- to <24-month-old groups, respectively. Costs were driven by missed parent work days.

CONCLUSIONS

From a societal perspective, trading 0.30 to 4 quality-adjusted life-days to avoid 1 antibiotic course might be desirable; from a parental perspective, this may not be as desirable. Parent demand for antibiotics may be rational when driven by the value of parent time. Other approaches that have the potential to reduce antibiotic use, such as wider use of influenza vaccine and improved rapid viral diagnostic techniques, might be more successful.

Authors+Show Affiliations

University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, Room 108, Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104, USA. meropols@mail.med.upenn.edu

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Review

Language

eng

PubMed ID

18381529

Citation

Meropol, Sharon B.. "Valuing Reduced Antibiotic Use for Pediatric Acute Otitis Media." Pediatrics, vol. 121, no. 4, 2008, pp. 669-73.
Meropol SB. Valuing reduced antibiotic use for pediatric acute otitis media. Pediatrics. 2008;121(4):669-73.
Meropol, S. B. (2008). Valuing reduced antibiotic use for pediatric acute otitis media. Pediatrics, 121(4), pp. 669-73. doi:10.1542/peds.2007-1914.
Meropol SB. Valuing Reduced Antibiotic Use for Pediatric Acute Otitis Media. Pediatrics. 2008;121(4):669-73. PubMed PMID: 18381529.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Valuing reduced antibiotic use for pediatric acute otitis media. A1 - Meropol,Sharon B, PY - 2008/4/3/pubmed PY - 2008/5/1/medline PY - 2008/4/3/entrez SP - 669 EP - 73 JF - Pediatrics JO - Pediatrics VL - 121 IS - 4 N2 - OBJECTIVE: The 2004 American Academy of Pediatrics acute otitis media guidelines urge parents to weigh the benefits of reduced antibiotic use, adverse drug events, and future resistance versus risks of extra costs and sick days resulting from guideline use. The value of decreased antibiotic resistance has not been quantified. The objective was to perform cost-utility analysis, estimating the resistance value of implementing the guidelines for acute otitis media treatment for children <2 years of age. Outcomes were described with a common denominator and the value of avoiding resistance was estimated using a parental perspective. METHODS: Decision analysis results were used for outcome probabilities. Published utilities were used to describe outcomes in quality-adjusted life-day units. The minimum resistance benefit value, where the benefits of the American Academy of Pediatrics guidelines would at least balance their costs, was defined as the guidelines' incremental costs minus their other benefits. RESULTS: For a child 2 to <6 months of age presenting to a primary care physician with possible otitis media, parents would need to value the resistance benefit at 0.77 quality-adjusted life-days per antibiotic prescription avoided for the guidelines' benefits to balance their costs. For the 6- to <24-month-old group, results were 0.67 quality-adjusted life-days per prescription avoided. Results were sensitive to the dollar cost utility; when willingness to pay ranged from $20,000 to $200,000 per quality-adjusted life-year, results ranged from 0.36 and 0.30 quality-adjusted life-days up to 4.10 and 3.57 quality-adjusted life-days for the 2- to <6-month-old and 6- to <24-month-old groups, respectively. Costs were driven by missed parent work days. CONCLUSIONS: From a societal perspective, trading 0.30 to 4 quality-adjusted life-days to avoid 1 antibiotic course might be desirable; from a parental perspective, this may not be as desirable. Parent demand for antibiotics may be rational when driven by the value of parent time. Other approaches that have the potential to reduce antibiotic use, such as wider use of influenza vaccine and improved rapid viral diagnostic techniques, might be more successful. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/18381529/Valuing_reduced_antibiotic_use_for_pediatric_acute_otitis_media_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=18381529 DB - PRIME DP - Unbound Medicine ER -