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

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.