Less Expensive But Equally Effective Antibiotics To Treat Ear Infections Could Reduce Medicaid Expenditures

Press Release Date: October 6, 1997

Treating common ear infections in children with antibiotics such as amoxicillin instead of more costly choices could save millions of dollars a year without changing recovery rates, according to researchers supported by the federal Agency for Health Care Policy and Research. Their study, which looked at children covered under Colorado's Medicaid program, is published in the October issue of Pediatrics.

Middle ear infection—or otitis media—is the most frequent reason for giving antibiotics to children in the United States. Doctors can select from a large number of antibiotics, but no single antibiotic has been found to be superior to another for treating this condition. However, costs vary widely, from $2.94 to $62.80, for example, for a 10-day course of antibiotics for a 19 to 24-month-old child.

Researchers found that more expensive antibiotics, such as amoxicillin/clavulanate or cephalosporins, accounted for only 30 percent of the prescriptions written for the studied population, but up to 77 percent of the more than $2 million spent for medications. In contrast, amoxicillin and other less expensive antibiotics, which worked just as well, accounted for 67 percent of the prescriptions but only 21 percent of the costs. There were no financial incentives or disincentives to influence physicians to choose one antibiotic over another. In general, hospital outpatient department and community health center doctors tended to prescribe less expensive antibiotics while their office-based counterparts generally prescribed more expensive ones.

According to the investigators, if, in 1992, only half the prescriptions in the study for cefaclor, cefixine, and amoxicillin/clavulanate instead had been written for amoxicillin alone, Colorado's Medicaid program would have saved $399,412.

The study, conducted by Stephen Berman, M.D., and other researchers at the University of Colorado Health Sciences Center, looked at 12,381 children 13 years of age and younger who were enrolled in Colorado's fee-for-service Medicaid program, and who were treated for a new episode of acute otitis media in 1991 and 1992. The article, entitled "Otitis Media-related Antibiotic Prescribing Patterns, Outcomes, and Expenditures in a Pediatric Medicaid Population," was a component of AHCPR's Pharmaceutical Outcomes Research Program.

For additional information, contact AHCPR Public Affairs: Karen Carp, (301) 427-1858 (KCarp@ahrq.gov); Salina Prasad, (301) 427-1864. For interviews with Dr. Berman or any of the other researchers, please contact Sarah Ellis, (303) 315-5571, at the University of Colorado Health Sciences Center.