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PEDIATRICS Vol. 105 No. 1 January 2000, pp. 156-157
To the Editor.
In a recent publication, Carabin and colleagues attempted to
estimate the direct and indirect costs of infectious diseases attributable to day care attendance among Canadian
toddlers.1 Although the researchers provided a thorough
analysis of the expenses incurred by the parents of sick children,
their estimates are ultimately limited by one major omission. Otitis
media (OM) is a common illness among Canadian children, and the
incidence of the disease is on the rise.2 OM is also a
common reason for visits to physicians' offices, the consumption of
antibiotics and over-the-counter medicines, as well as minor surgical
interventions such as myringotomy with tympanotomy tube placement.
Annual treatment expenditures for OM have been estimated to exceed $600
million in Canada.3 Furthermore, numerous studies have
demonstrated that day care attendance is a major risk factor for
OM.4-7
It is difficult to understand why the authors failed to include OM in
their analysis of the costs of day care-related illness, considering
the fact that 50 (18.3%) children in their study suffered from chronic
OM (see Table 1A, page 559). The average costs of treating an initial
episode of OM exceed $100.8 In cases of chronic OM,
treatment costs range from several hundred to more than $1000 dollars,
depending on the method of management.9 By failing to
consider expenditures for OM, the researchers ignored an important
contribution to the economic burden of day care-related illness.
Greenville, NC 27858
REFERENCES
In Reply.
We included direct costs related to OM and other specific
diseases of preschool-aged children attending day care in the
calculation of direct costs under both medication and
visit to a physician. All prescription drugs and
over-the-counter drugs purchased by the parent over the first 6 months
of the study for episodes of colds, diarrhea and/or vomiting
caused by
any illnesswould have been indicated on the daily calendar from which
we estimated costs. Our definition of colds included OMor at least
its first symptoms. Therefore, most of the costs associated with OM
were included. Instances of visits to physicians in a hospital setting
would be captured in the section on visit to a physician.
Although, in Quebec, fees associated with visits to a physician and
hospitalization are not directly paid by parents, we used, in our
estimation of direct costs, a weighted average of the costs for a visit
to a physician based on information (eg, type of physician, type of setting) provided by parents in the baseline questionnaire, which included data over the previous 4 weeks. Because it was not feasible to
obtain all cost data for the hospitalizations (eg, duration, medication
use during the hospitalization), we included only costs for visits to a
physician and acknowledged that we are underestimating the true costs.
It was not possible for us to estimate the magnitude of this
underestimation, but readers might be able to appreciate it in their
own public or private health care settings. Expenditures for children
in our study, who attend daycare and who suffered from OM, would have
been included in our cost estimates. The general issue of including
hospitalization data is correctly identified by Mr. Curry as being an
important component of this type of analysis.
University of Oxford
The Wellcome Forest Centre for the Epidemiology of Infectious Disease
Oxford, England OX1 3PS
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