Economic impact of in-office pediatric tympanostomy tube placement using a tympanostomy tube delivery device in a commercially- and Medicaid-insured US population

Abstract

Aims: Pediatric tympanostomy tube placement (TTP) is performed primarily in operating room (OR) settings under general anesthesia. Recent studies have demonstrated TTP completed in the otolaryngologist’s office with a topical anesthetic and delivery device to be safe and effective. This study estimated the financial impact to commercial and Medicaid health plans by shifting pediatric TTP from the OR to an office setting. Materials and methods: This budget impact model estimated the financial impact of using the Hummingbirdi Tympanostomy Tube System (HTTS) for in-office pediatric tympanostomy tube placement by shifting 25% of utilization away from the OR–hospital outpatient department (HOPD) or ambulatory surgery center (ASC)–in a commercially- and Medicaid-insured population. Results: The annual TTP estimate in a one-million-member health plan was 2,872 for a commercial plan and 4,534 for a Medicaid plan. Cost inputs for HOPD and ASC procedures were $5,743 and $3,609 (Commercial) and $2,199 and $1,663 (Medicaid), respectively. Cost inputs for in-office procedures utilizing HTTS were $2,000 (Commercial) and $1,600 (Medicaid). All surgical cost estimates assumed a bilateral (two ear) procedure. A 25% shift led to cost savings of $1,991,790 (14.5%) for commercial plans and $365,562 (4.2%) for Medicaid plans; translating into $0.17 per member per month (PMPM) and $58 per treated member per month (PTMPM) savings in a commercial plan and $0.03 PMPM and $7 PTMPM in Medicaid. Per patient cost of TTP decreased by $3,743/65.2% (HOPD) or $1,609/44.6% (ASC) for Commercial and $519/24.5% (HOPD) and $63/3.8% (ASC) for Medicaid. Limitations: Costs in HOPD and ASC setting were based on averages in the MarketScan administrative claims databases which are limited by contributor, data coding, and entry errors. Conclusions: In-office TTP utilizing HTTS substantially reduces cost for U.S. commercial and Medicaid health insurers, offering a significant opportunity to deliver value-based care.