Prescribing patterns and expenditures for otitis media-related antibiotics for children in the Texas Medicaid program



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Otitis Media (OM) is the most common childhood infection in the United States and it is associated with significant antibiotic use and a high economic burden. The primary objective of this study was to determine the prescribing patterns and expenditures for OM-related antibiotics among the Texas Medicaid pediatric population. The second objective was to identify the demographic and antibiotic-related factors associated with the mean prescription cost for OM-related antibiotics. Children who were younger than 13 years old with a diagnosis of OM (ICD-9:381.x-382.x) and had at least one OM-related antibiotic prescription between January 1, 2008 and August 31, 2011 were identified from the Texas Medicaid database. OM-related antibiotics were selected based on the guidelines proposed by the American Academy of Pediatrics and the American Academy of Family Physicians in 2004, and were classified into three categories: cephalosporins (cefdinir, cefpodoxime, cefuroxime, ceftriaxone), macrolides (azithromycin, clarithromycin) and penicillins (amoxicillin, amoxicillin-clavulanate). The total numbers (proportions) of prescriptions and costs were compared across selected antibiotics and categories. A generalized linear model was used to evaluate potential factors associated with mean costs of OM-related antibiotic prescriptions. A total of 645,161 children with a mean age of 3.8 (SD=3.1) years were included. The majority were boys (52.1%), younger than 3 years old (55.2%) and Hispanic (51.7%). OM-related antibiotic prescription claims (expenditures) decreased from 224,257 in 2008 ($8,335,964) to 135,789 in 2010 ($4,013,347). In 2011, OM-related antibiotic prescription claims (expenditures) increased to 203,541 ($5,970,959). The most frequently used category of OM-related antibiotics was penicillins (491,812 claims). Amoxicillin was the most frequently prescribed OM-related antibiotic (53.1%). However, the total outpatient prescription cost was highest for cefdinir ($10,950,719). Additionally, higher age, Hispanic ethnicity, male gender, fee-for-service program enrollment, pediatricians, and all selected antibiotics were significant predictors (p<0.01) of higher mean costs for OM-related antibiotic prescriptions. The study indicated a downward trend in total number of prescription claims and expenditures for selected OM-related antibiotics between 2008 and 2010 in the Texas Medicaid pediatric population. It also indicated an upward trend in OM-related antibiotics use in 2011, which suggests a possible reason for concern regarding antibiotic resistance. To control the high cost of OM-related antibiotic prescriptions, policy makers could strengthen efforts to educate physicians to promote appropriate antibiotic use for OM.