Petrou, Stavros, Dakin, Helen, Abangma, Giselle, Benge, Sarah and Williamson, I. (Ian), Dr.. (2010) Cost–utility analysis of topical intranasal steroids for otitis media with effusion based on evidence from the GNOME Trial. Value in Health, Vol.13 (No.5). pp. 543-551. ISSN 1098-3015

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Abstract

Objectives To estimate the cost-effectiveness of topical intranasal steroids for the treatment of otitis media with effusion (OME) in primary care from the perspective of the UK National Health Service. Methods An economic evaluation was conducted based on evidence from the double-blind, randomized, placebo-controlled GPRF [General Practice Research Framework] Nasal Steroids for Otitis Media with Effusion (GNOME) trial. Participants comprised 217 children aged 4–11 years who had at least one episode of otitis media or related ear problem in the previous 12 months and had tympanometrically confirmed bilateral OME. Children were randomly allocated to receive either mometasone furoate 50 µg or placebo spray once daily into each nostril for 3 months. The main outcome measure was the incremental cost per quality-adjusted life-year (QALY) gained for topical steroids compared with placebo. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves at alternative willingness to pay thresholds. Results Children receiving topical steroids accrued nonsignificantly higher costs (incremental cost/child: £11, 95% confidence interval [CI]: −£199 to £222) and nonsignificantly fewer QALYs (incremental QALY gain/child: −0.0166, 95% CI: −0.0652 to 0.0320) than those receiving placebo. Topical steroids had a 24.19% probability of being cost-effective at a £20,000 per QALY gained threshold, a 23.82% probability of being more effective and a 46.25% probability of being less costly. Sensitivity and subgroup analyses showed incremental costs and benefits to be highly sensitive to the methods used and the patient group considered, although differences between groups did not reach statistical significance in any analysis. Conclusions Topical steroids are unlikely to be a cost-effective treatment for OME in general practice.

Item Type:	Journal Article
Subjects:	R Medicine > RF Otorhinolaryngology R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Otitis media with effusion in children -- Treatment -- Cost-effectiveness, Intranasal medication -- Evaluation, Placebos (Medicine), Clinical trials
Journal or Publication Title:	Value in Health
Publisher:	Wiley-Blackwell Publishing, Inc.
ISSN:	1098-3015
Date:	July 2010
Volume:	Vol.13
Number:	No.5
Page Range:	pp. 543-551
Identification Number:	10.1111/j.1524-4733.2010.00711.x
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	NIHR Health Technology Assessment Programme (Great Britain) (NIHR HTA), Medical Research Council (Great Britain) (MRC)
URI:	http://wrap.warwick.ac.uk/id/eprint/37044

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