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. 2023 Jan;280(1):175-181.
doi: 10.1007/s00405-022-07483-8. Epub 2022 Jun 22.

Healthcare consumption among subjects with otitis media undergoing middle ear surgery-analysis of cost drivers

Aaran T Lewis  1 , Douglas Backous  2 , Byung Yoon Choi  3 , Rafael Jaramillo  4 , Kelvin Kong  5 , Thomas Lenarz  6 , Jaydip Ray  7 , Alok Thakar  8 , Krister Järbrink  1 , Myrthe K S Hol  9   10
Affiliations

Healthcare consumption among subjects with otitis media undergoing middle ear surgery-analysis of cost drivers

Aaran T Lewis et al. Eur Arch Otorhinolaryngol. 2023 Jan.

Abstract

Purpose: To map healthcare utilized by subjects with chronic otitis media, with or without cholesteatoma and perform a cost analysis to determine key drivers of healthcare expenditure.

Methods: A registry study of 656 adult subjects with chronic otitis media that underwent a middle ear surgery between 2014 and 2018. Healthcare contacts related to all publicly funded specialist ENT care, audiological care and primary care for a disease of the ear and mastoid process were extracted. The data are extracted from the Swedish National Patient Registry on subjects that reside in western Sweden.

Results: Subjects made 13,782 healthcare contacts at a total cost 61.1 million SEK (6.0 million EUR) between 2014 and 2018. The mean cost per subject was 93,075 SEK (9071 EUR) and ranged between 3971 SEK (387 EUR) and 468,711 SEK (45,683 EUR) per individual. In the most expensive quartile of subjects, mean cost was 192,353 SEK (18,747 EUR) over the 5-year period. These subjects made 3227 ENT contacts (roughly four each year) and 60% of total costs were associated with in-patient ENT care.

Conclusion: Patients with chronic otitis media are associated with high ENT resource utilization that does not diminish after surgical intervention and the disease places a long-term burden on healthcare systems. Significant costs are attributed to revision surgeries, indicating that these patients could be managed more effectively. In many such cases, reoperation cannot be avoided, especially due to recurrence of cholesteatoma. However, in some patients, when the indication for subsequent surgery is only hearing improvement, alternative options, such as hearing aids or implants, should also be considered. This is especially true in difficult cases, where revision ossiculoplasty is likely.

Keywords: Audiological care; Cholesteatoma; Cost analysis; Economic burden; Healthcare costs; Hearing loss; Middle ear surgery; Otitis media.

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Conflict of interest statement

KJ is a former employee of Cochlear Limited and ATL is a current employee of Cochlear Limited, a manufacturer and supplier of hearing devices.

Figures

Fig. 1
Fig. 1
Centiles of total cost for all patients by category of care in SEK
Fig. 2
Fig. 2
Mean yearly cost in SEK for the years before and after first-reported middle ear surgery (time point 0) for the costliest patient quartile. Error bars represent the standard error of the mean
Fig. 3
Fig. 3
Mean yearly cost in SEK for the years before and after ossiculoplasty (time point 0) for all patients that underwent ossiculoplasty. Error bars represent the standard error of the mean
See this image and copyright information in PMC

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