Cost and effectiveness of ciprofloxacin + hydrocortisone versus neomycin + polymyxin B + hydrocortisone in France for the treatment of acute otitis externa

Summary

The cost-effectiveness of two topical otic combinations, ciprofloxacin + hydrocortisone and polymyxin B — neomycin — hydrocortisone (PNH), was assessed in the treatment of acute otitis externa (AOE). Two randomised controlled double-masked trials compared their clinical and bacteriological efficacy and safety after 7 to 10 days of qid treatment. The treatment failure cost was established from a panel of ENT specialists and GPs. A decision-tree analysis was constructed to reproduce the results of empirical treatment. The most often encountered species were Pseudomonas aeruginosa (82.4%) and Staphylococcus aureus (9.7%). Patients documented with P aeruginosa had a better ciprofloxacin + hydrocortisone bacterial and clinical efficacy. The cost of AOE first-line failure was EUR 94.44 (Societal) and EUR 57.24 (Sécurité Sociale). The savings associated with ciprofloxacin + hydrocortisone (Cipro HC ®) were respectively EUR 3.87 and EUR 2.85. This model shows that topical ciprofloxacin + hydrocortisone could be a cost saving alternative in the treatment of AOE, provided its public price does not exceed EUR 10.60.

Cipro HC® is a registered trademark of Alcon, France.

Key words: :

• acute otitis externa
• ciprofloxacin
• neomycin
• polymixin
• economics
• cost of failure