Purpose. The purpose of this study was to compare the cost-effectiveness of ototopical ciprofloxacin/dexamethasone (CD) to oral amoxicillin/clavulanic acid (ACA) for the treatment of acute otitis media in tympanostomy tube (AOMT) patients.

Methods. A decision-analytic cost-effectiveness model was used to emulate the costs and consequences of two alternative AOMT therapeutic pathways: ototopical CD versus oral ACA. Data for this analysis were derived from several sources: a randomized clinical trial, the medical literature, standard cost references and a physician practice pattern survey. The physician practice pattern survey was used to develop the clinical algorithms for the alternative therapeutic pathways. The economic outcome of interest was the expected cost per clinical cure for the alternative therapeutic pathways. Three tiers of antimicrobial AOMT therapy were modeled for each therapeutic pathway. Each successive tier of therapy represented the re-treatment of clinical failures from the preceding tier. First-tier therapy compared CD and ACA clinical outcomes and resource utilization using data taken from a randomized clinical trial. Second- and third-tier antibiotic preferences, resource utilization, and clinical outcomes were taken from an AOMT practice pattern survey of 300 physicians. ACA was modeled as the second-tier antibiotic used to retreat the CD therapeutic failures while CD was modeled as the second-tier antibiotic used to retreat the ACA therapeutic failures. Oral cefdinir was modeled as the preferred third-tier antibiotic used to retreat second-tier failures irrespective of the preceding antibiotic used. Only the direct costs associated with therapy were used in the analysis. Costs were taken from standard reference sources and presented from the payer's perspective. Lab tests and side effect costs were weighted based on the number of physician mentions in the physician practice pattern survey. Univariate sensitivity analyses were performed on the model parameters to evaluate the assumptions and conclusions of the economic model.

Results. Initiating AOMT therapy with CD incurred lower costs than initiating treatment with ACA. The expected cost per cure was $219 per patient in the CD therapeutic pathway versus $293 in the ACA therapeutic pathway.

Conclusion. Due to differences in effectiveness and side effects, ototopical CD was more cost-effective than oral ACA for the treatment of AOMT. CD therapy dominated ACA therapy in spite of CD's higher acquisition cost.