TABLE 1

Assumptions Concerning Otitis Media and Vaccine Effectiveness Used in the Decision Analysis Model

Model ElementBase-Case AssumptionRange for Sensitivity AnalysisSource of Data
Natural history
    Average monthly probability of AOM for:Base case: Northern California Kaiser Permanente; sensitivity analyses: Pittsburgh Child Development/Otitis Media Study cohort and HVMA
        Children with no history of otitis media during agesa
            1–6 mo0.070.03–0.35
            7–12 mo0.15
            13–18 mo0.11
            19–24 mo0.08
            25–36 mo0.06
            37–48 mo0.05
        Children with a history of otitis media during agesb
            1–6 mo0.210.009–0.78
            7–12 mo0.50
            13–18 mo0.44
            19–24 mo0.37
            25–36 mo0.31
            37–48 mo0.24
    Average monthly probability of OME for:Base case: Northern California Kaiser Permanente; sensitivity analyses: Pittsburgh Child Development/Otitis Media Study cohort and HVMA
        Children with no history of otitis media during ages 1–48 moa0.0004–0.0007
        Children with a history of otitis media during ages 1–48 mob0.0006–0.03
Tympanostomy-tube condition
    Probability of insertion if child eligiblec0.180.06–0.36Owings and Kozak3 (1998)
    Proportion of insertions that result in complication0.06Owings and Kozak3 (1998)
    Effectiveness against AOMd0.750.25–1.00Mandel et al24 (1992)
Monthly vaccine effectivenesse
    PCV7 vaccine, during ages, %
        4–24 mo6.44.0%–20.0%Fireman et al5 (2003)
        25–36 mo3.22.0%–10.0%
        37–48 mo1.61.0%–5.0%
    Pneumo-NTH combination vaccine, during ages, %
        4–24 mo28.010.0%–50.0%Prymula et al12 (2006)
        25–36 mo14.05.0%–25.0%
        37–48 mo7.02.5%–12.5%
    Pneumo-NTH–Moraxella combination vaccine, during ages, %
        4–24 mo31.5Similar to Pnuemo-NTH assumptions abovePrymula et al12 (2006)
        25–36 mo15.75
        37–48 mo7.87
    Vaccinations that result in parent time costs for adverse event, %20%–10%Lieu et al17 (2000)
  • a Male child.

  • b Male child with a history of otitis media, including first otitis media episode at 2 months of age and 3 AOM episodes in preceding 6 months.

  • c Tympanostomy-tube eligibility was defined as a history of 3 AOM episodes in the past 6 months or 4 AOM episodes in the past year. Eligibility was determined by calibrating the decision model so that rates of the tympanostomy-tube insertion matched rates from unpublished analyses of the 1996 National Hospital Discharge Survey and the 1996 National Survey of Ambulatory Surgery.

  • d Tympanostomy tubes were assumed to remain effective for an average of 1 year.25

  • e Monthly vaccine effectiveness values were selected so that overall vaccine effectiveness results matched those of published sources. The expert panel suggested the vaccine effectiveness waning pattern of 50% during the third year of life and 50% during the fourth year of life. Estimates of pneumococcal conjugate vaccine monthly effectiveness were calibrated to match the 6.6% overall effectiveness during the first 3.5 years of life reported by Fireman et al.5 Combined pneumo-NTH monthly vaccine estimates were calibrated to match the overall vaccine effectiveness of 33.6% during the first 2 years of life reported by Prymula et al.12 Monthly vaccine effectiveness estimated for the combined pneumo-NTH–Moraxella vaccine were calibrated to match an estimated 38.2% effectiveness during the first 2 years of life, based on an extrapolation from data reported by Prymula et al.12