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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1352-1356

Initial and Follow-up Costs by Treatment Outcome for Children With Respiratory Infections

David H. Howard, PhD* and John E. McGowan, Jr, MD{ddagger}

* Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
{ddagger} Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia

Objective. To estimate the initial and follow-up costs of treatment of respiratory infections among pediatric patients and the relationship between costs and outcomes.

Methods. A total of 3677 episodes of care from 2328 patients who were <17 years of age and had respiratory or ear infections that were treated with an antibiotic initially. The sample was drawn from the Medical Expenditure Panel Surveys for the years 1996 through 1999. Treatment failure was defined as the receipt of a second antibiotic, different from the first, in a 4-week window. We compared follow-up costs by outcome (treatment failure vs success) using a 2-part model of medical costs. We also performed a paired analysis by selecting 2 episodes, one in which the outcome was failure and the other in which the outcome was success, for patients with at least 1 of each type and computing the difference in costs.

Results. Follow-up costs for provider visits for episodes for which the patient experienced treatment failure were $216 versus $53 for episodes for which the patient did not experience treatment failure. Follow-up drug costs, including the cost of the second antibiotic, were $75 for children who experienced treatment failure versus $23, respectively. Cost estimates from the paired analysis were similar, confirming that results are not biased by unobserved time-invariant patient characteristics.

Conclusion. Children who have respiratory infections and experience treatment failure incur substantially higher costs.

Key Words: antibiotic use • cost analysis • otitis media

Abbreviations: MEPS, Medical Expenditure Panel Survey • URI, upper respiratory infection

Received for publication Jun 16, 2003; Accepted Sep 21, 2003.




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