Abstract

THE ECONOMIC BURDEN OF ACUTE BACTERIAL RHINOSINUSITIS AND ACUTE OTITIS MEDIA IN TURKEY: AN EPIDEMIOLOGY BASED COST OF ILLNESS STUDY WITH RESPECT TO CLINICAL PRACTICE AND AVAILABLE GUIDELINES

Ergun Oksuz*, Simten Malhan and Serhat Unal

Abstract

Objective: To estimate economic burden of acute bacterial rhinosinusitis (ABRS) and acute otitis media (AOM) in Turkey via an epidemiology-based cost of illness study with respect to clinical practice and available guidelines. Methods: This cost of illness study was based on identification of per patient direct medical costs and per patient and total annual treatment costs for the management of adult and pediatric patients with ABRS and AOM in Turkey with respect to practice patterns in clinical practice and per guideline recommendations. Average per patient direct medical cost in primary, secondary and tertiary-care management of ABRS and AOM was calculated based on cost items related to physician visits, diagnostic laboratory and radiological tests, drug treatment, hospitalizations and interventions. Total annual treatment cost was calculated via prevalencebased extrapolation of per patient annual treatment costs for different health conditions managed in clinical practice and per guideline recommendations as well as in case of 5% higher antibiotic resistance. Results: Average per patient annual treatment costs in clinical practice were US$ 24.29 for pediatric ABRS, US$ 26.83 for adult ABRS, US$ 25.70 for pediatric AOM and US$ 27.10 for adult AOM, while adherence to guidelines was associated with per patient US$ 3.09, US$ 5.84, US$ 2.95 and US$ 2.13 cost reductions, respectively. Total annual treatment cost was US$ 101,499,040 for ABRS and US$ 57,191,330 for AOM in clinical practice along with 20% (US$ 20,260,100) and 9.8% (US$ 5,626,990) cost reductions, respectively in case of adherence to guidelines. In case of 5% higher antibiotic resistance, total annual antibiotic treatment costs were increased by 18.3% (US$ 18,593,590) in ABRS and by 14.1% (US$ 9,063,630) in AOM. Conclusions: In conclusion, our findings indicate that ABRS and AOM pose a considerable burden to health economics in Turkey, with antibiotic prescription identified as the main cost driver and emphasize the likelihood of substantial cost savings by adherence to guideline recommendations and reduced antibiotic resistance.

Keywords: acute bacterial rhinosinusitis; acute osteomyelitis; practice patterns; cost analysis; antibiotic prescription; clinical practice; guidelines; Turkey.