OBJECTIVES: Tympanostomy tube (TT) placement is an established treatment for recurring otitis media (OM), an ear-related condition occurring in ~90% of children by age 4 and posing a significant economic burden, with greater than $4B USD in annual costs. As limited data documenting economic outcomes in this area exist, this study assessed direct medical costs following TT placement in real-world settings.
METHODS: Insurance claims (1/2010-12/2013) of commercially insured and Medicaid-enrolled children (less than or equal to 17 years) were analyzed. Inclusion criteria included: medical claim for TT placement (CPT code 69436 and/or ICD-9-CM procedure code 20.01), and continuous health plan enrollment for greater than or equal to 180 days before and greater than or equal to 360 days following the procedure. Predicted, adjusted medical costs (i.e., total; office and emergency room [ER] visit-related) of ear-related care, among those receiving such care during the 360-day follow-up period, were generated following estimation of multivariable generalized linear regression models. Results were generated overall, as well as stratified by commercially insured and Medicaid-enrolled patients.
RESULTS: 198,078 patients (72,932 Medicaid-enrolled, 125,146 commercially insured) met all inclusion criteria and received ear-related care in any setting during the follow-up period. This analysis revealed that in the 360 days following initial TT placement, mean (SD), predicted, adjusted total costs for earrelated conditions were $456 ($4,174). For commercially insured and Medicaid-enrolled patients, these were $555 ($5,013) and $286 ($2,035), respectively (P less than 0.0001). ER-related costs for ear conditions were $187 ($247) overall, $427 ($293) for commercially insured, and $63 ($51) for Medicaid-enrolled (p less than 0.0001). Finally, office visit-related costs for ear conditions were $162 ($90) overall, $195 ($86) for commercially insured and $102 ($64) for Medicaid-enrolled (p less than 0.0001).
CONCLUSIONS: Predicted, adjusted costs are significantly greater in commercially insured patients, demonstrating significantly lower reimbursement to providers who care for Medicaid pediatric patients. Health care decision makers should be aware of these findings as they develop plans to allocate resources in the pediatric setting.
