TABLE 3

Assumptions Regarding Costs and QALYs Used in the Decision Analysis Model

AssumptionBase CaseRange for Sensitivity AnalysisSource
Medical costs, $
    Outpatient visit for AOM or OMEb51.2338.00–100.00Base case: American Academy of Pediatrics, 2006; sensitivity analysis: assumption
    Antimicrobial agents for single episode of AOMc
        1–12 mo10.3815.57–18.17Drug Topics Red Book27 (2005)
        13–24 mo16.4424.6–28.77
        25–36 mo19.3529.02–33.86
        37–48 mo21.6832.52–37.94
    Antimicrobial agents for recurrent AOMd
        1–12 mo16.7725.16–29.35
        13–24 mo25.7138.57–44.99
        25–36 mo30.2445.36–52.92
        37–48 mo33.6450.46–58.87
    Tympanostomy-tube insertion1694847–3388Medicare fee schedule30
    Tympanoplasty55742787–11 148Medicare fee schedule30
Parental time costs associated with otitis media, $
    Parental time cost for AOM or medically attended OMEe39.80Lieu et al28 (1994)
    Parental time for transportation and other work loss associated with AOM or medically attended OME f77.60Capra et al14 (2000)
    Parental time cost for tympanostomy tube insertiong318.40Assumption
Vaccination cost per dose, $
    PCV764.845–200CDC vaccine price list35 (2006)
    Combined pneumo-NTH vaccine100.005–200Assumption
    Combined pneumo-NTH–Moraxella vaccine125.00Not performedAssumption
    Vaccine administration costh12.06F Zhou, PhD, written communication, 2004
    Outpatient visit for adverse event51.2338–100American Academy of Pediatrics56 (2006); sensitivity analysis: assumption
    Parental time for adverse eventI238.80
QALYs lost because of conditionProsser et al33 (2004) and unpublished data
    AOM0.0110.005–0.020
    Tympanostomy-tube insertion0.110.05–0.20
    Pneumonia0.18Not performed
    Complicated pneumonia0.59Not performed
    Bacteremia0.21Not performed
    Meningitis0.76Not performed
  • CDC indicates Centers for Disease Control and Prevention.

  • a Costs are reported in 2006 dollars.

  • b Base-case outpatient visit cost was a weighted average of state Medicaid charges and commercial payments as reported by the American Academy of Pediatrics.56 The Current Procedural Terminology code used for the outpatient visit cost calculation was 99213.

  • c Costs for antimicrobials were calculated by using a weighted average of costs for the most commonly prescribed antibiotics in each age group. For example, the antimicrobial cost for a single episode of AOM for children aged 1 to 12 months was based on a weighted average of the costs of the following prescribed antimicrobials: amoxicillin 85%, trimethoprim-sulfamethoxazole 7.5%, erythromycin ethyl succinate and acetylsulfisoxazole 3.7%, amoxicillin-clavulanate 2%, and cefixime 1%. This distribution was derived from use data from HVMA (see text for details).

  • d Recurrent AOM was defined as ≥3 episodes in the previous 6 months.

  • e Parental time costs were calculated using an average hourly wage of $19.90. Time costs of 2 hours were used to calculate cost-effectiveness ratios, because travel and work-loss time were included in QALY derivations.

  • f Parental time costs were based on an assumption of a total 3.9 hours of work loss.

  • g Parental time costs were based on an assumption of 2 days of work loss.

  • h Administration costs consist of supplies, personnel, and overhead costs.

  • i Parental time costs were based on assumption of 1.5 days of work loss.