Background: Infectious conjunctivitis affects one in eight children annually, resulting in high ophthalmic antibiotic prescribing and absenteeism from childcare and school. We aimed to quantify the cost-effectiveness and annual savings of three evidence-based approaches to conjunctivitis management and return to childcare and school compared to usual care.
Methods: Using a decision analytic model from a societal perspective over a one-year time horizon, we conducted a cost-effectiveness analysis of three management strategies for children aged 6 months-17 years with non-severe conjunctivitis compared to usual care in the United States. Strategies accounted for rate of transmission. Strategies included 1) refraining from prescribing ophthalmic antibiotics for non-severe conjunctivitis, 2) allowing children without systemic symptoms to attend childcare and school, 3) and the combined approach of refraining from prescribing ophthalmic antibiotics and allowing children without systemic symptoms to attend childcare and school.
Results: The estimated annual expenditure for pediatric conjunctivitis was $1.95 billion. Usual care was the most expensive ($212.73/episode), followed by refraining from ophthalmic antibiotic prescribing ($199.92) and allowing children without systemic symptoms to attend childcare and school ($140.18). The combined approach was the least costly ($127.38). Disutility was similar between approaches (quality adjusted life days 0.271 v 0.274). Refraining from antibiotic prescribing and the combination approach were dominant compared to usual care. The combined approach resulted in an estimated $783 million annual savings and 1.6 million ophthalmic antibiotic courses averted.
Conclusions: Conjunctivitis poses an economic burden which could be reduced by refraining from ophthalmic antibiotic use and allowing children without systemic symptoms to remain at school or childcare.
Keywords: Antibiotic Stewardship; Conjunctivitis; Cost-Effectiveness; Guidelines; Pediatrics.
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