Cost to implement an outpatient stewardship intervention for acute otitis media (AOM)
Leisha M. Andersen, Sophie E. Katz, Amy Keith, Theresa L. Morin, Timothy C. Jenkins, Alexander S. Plattner, Evan Facer, Sherry Dodd, Sharon Graham, Holly M. Frost,Abstract
Objective:
Most children 2 years and older with uncomplicated acute otitis media (AOM) are prescribed 10-day antibiotic durations, despite national guidelines recommending antibiotics for 5–7 days. Costs are often cited as a barrier to stewardship efforts. As part of a larger clinical trial including 2 systems and 46 clinics, we developed a low-intensity and a high-intensity intervention aimed at reducing antibiotic duration for AOM and evaluated implementation and sustainability for the interventions.
Methods:
Costs associated with each implementation activity were recorded over time, including material/supply costs (eg, printing) and personnel time costs. Sustainability costs were estimated based on ongoing implementation expenses. For each system, we assessed total intervention, activity-specific, and sustainability costs. Aggregate results were reported as the median across systems.
Results:
The total median implementation costs were $3,606 (range $2,540–$4,672) for the low-intensity intervention and $9,203 (range $7,557–$10,849) for the high-intensity intervention. For the low-intensity intervention, the primary cost driver was electronic health record modifications totaling $2,292 (range $1,615–$2,968). For the high-intensity intervention, the primary cost driver was audit and feedback system activation totaling $5,597 (range $2,885–$8,309). Personnel time accounted for over 90% of costs in both study arms. Sustainability costs were $133/year (range $77–$190) for the low-intensity intervention and $764/year (range $628–$901) for the high-intensity intervention.
Conclusions:
Overall costs were low. The high-intensity intervention resulted in higher costs compared to the low-intensity intervention.