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Variation in utilization and need for tympanostomy tubes across England and New England

Authors/Editors: Parker, D.M.
Schang, L.
Wassermann, J.R.
Viles, W.D.
Bevan, G.
Goodman, D.C.
Publication Date: 2016
Type of Publication: Articles in Refereed Journals (International)
ISBN/ISSN: http://dx.doi.org/10.1016/j.jpeds.2016.08.093
erschienen in: The Journal of Pediatrics

Objectives: To compare rates of typmanostomy tube insertions for otitis media with effusion with estimates of need in 2 countries.


Study design: This cross-sectional analysis used all-payer claims to calculate rates of tympanostomy tube in-sertions for insured children ages 2-8 years (2007-2010) across pediatric surgical areas (PSA) for Northern New England (NNE; Maine, Vermont, and New Hampshire) and the English National Health Service Primary Care Trusts (PCT). Rates were compared with expected rates estimated using a Monte Carlo simulation model that integrates clinical guidelines and published probabilities of the incidence and course of otitis media with effusion.


Results: Observed rates of tympanostomy tube placement varied >30-fold across English PCT (N=150) and >3-fold across NNE PSA (N=30). At a 25 dB hearing threshold, the overall difference in observed to expected tympanostomy tubes provided was −3.41 per 1000 child-years in England and −0.01 per 1000 child-years in NNE. Observed incidence of insertion was less than expected in 143 of 151 PCT, and was higher than expected in one-half of the PSA. Using a 20 dB hearing threshold, there were fewer tube insertions than expected in all but 2 England and 7 NNE areas. There was an inverse relationship between estimated need and observed tube insertion rates.


Conclusions: Regional variations in observed tympanostomy tube insertion rates are unlikely to be due to differences in need and suggest overall underuse in England and both overuse and underuse in NNE.