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

Objective: To evaluate the cost-effectiveness of various topical prophylaxis strategies against posttympanostomy otorrhea using a break-even analysis.

Study design: An economic decision analysis of data collected from purchasing records and the literature.

Setting: An academic center.

Methods: Costs of various strategies were calculated by querying our institution's pharmacy as well as GoodRX.com 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 ( $\mathrm{ARR}$ ) in otorrhea rate to make prophylactic treatment cost-effective.

Results: The 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 ( $\mathrm{ARR}$ 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.

Conclusion: Prophylaxis 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.