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Cost–utility analysis of topical intranasal steroids for otitis media with effusion based on evidence from the GNOME Trial
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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. doi:10.1111/j.1524-4733.2010.00711.x ISSN 1098-3015.
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Official URL: http://dx.doi.org/10.1111/j.1524-4733.2010.00711.x
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 | ||||
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| Subjects: | R Medicine > RF Otorhinolaryngology R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| 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 | ||||
| Official Date: | July 2010 | ||||
| Dates: |
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| Volume: | Vol.13 | ||||
| Number: | No.5 | ||||
| Page Range: | pp. 543-551 | ||||
| DOI: | 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) |
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