Cost-utility analysis of tympanomastoidectomy for adults with chronic suppurative otitis media.

OBJECTIVE To undertake cost-utility analysis for tympanomastoid surgery to analyze its cost-effectiveness in treating adult chronic suppurative otitis media (CSOM). METHODS Seventy-seven patients with CSOM were evaluated with the Chronic Ear Survey (CES) before and 1 year after tympanomastoid surgery. Direct health care cost data during the 1st year after operation were retrieved. The utility gain was defined as change in the CES total score. The cost-utility ratio (CUR) was defined as cost per utility gain. Patients were stratified by disease type into wet-ear and dry-ear groups. RESULTS The average total direct cost attributable to tympanomastoid surgery is (in New Taiwan dollars) 45,716.3 in the 1st postoperative year, and the average CUR is 1850.9 New Taiwan dollars. The lower CUR of 1280.9 New Taiwan dollars for the wet-ear group is due to the greater utility gain (37.6 +/- 3.4 versus 24.4 +/- 6.8, P < 0.05) despite its higher cost (48,163.2 New Taiwan dollars versus 38,419.7 New Taiwan dollars, P < 0.05). CONCLUSIONS Treating continuously or intermittently draining ears is more cost-effective, as compared with managing a quiescent infection, because of its favorable utility gain.