Cost-Effectiveness of Topical Prophylaxis Against Tympanostomy Tube Otorrhea: An Economic Decision Analysis

ObjectiveTo evaluate the cost-effectiveness of various topical prophylaxis strategies against posttympanostomy otorrhea using a break-even analysis.Study DesignAn economic decision analysis of data collected from purchasing records and the literature.SettingAn academic center.MethodsCosts of various strategies were calculated by querying our institution's pharmacy as well as drug prices. Posttympanostomy otorrhea rates were acquired from a review of the literature. Costs for treatment of otorrhea were based upon our institution's self-pay patient charges. A break-even analysis was performed to determine the required absolute risk reduction (ARR $\mathrm{ARR}$) in otorrhea rate to make prophylactic treatment cost-effective.ResultsThe most expensive strategy ciprofloxacin/hydrocortisone otic ($626.83) was not cost-effective unless the rate of postoperative otorrhea was greater than 92% or if the cost of otorrhea treatment exceeded $4477.36. The cheapest antibiotic/steroid combination, ciprofloxacin/dexamethasone otic ($72.25) was cost-effective (ARR $\mathrm{ARR}$ 10%). Using a conservative initial otorrhea rate (14%) and weighted cost of treatment ($683.39), the most expensive cost-effective prophylactic intervention possible was $95.67.ConclusionProphylaxis against posttympanostomy otorrhea can be cost-effective. Physicians should consider the cost of prophylaxis at their institution as well as the patient's postoperative risk of otorrhea when making treatment decisions.