Cost to implement an outpatient stewardship intervention for acute otitis media (AOM).

Objective: Most children 2 years and older with uncomplicated acute otitis media (AOM) are prescribed 10-day antibiotic durations, despite national guidelines recommending antibiotics for 5-7 days. Costs are often cited as a barrier to stewardship efforts. As part of a larger clinical trial including 2 systems and 46 clinics, we developed a low-intensity and a high-intensity intervention aimed at reducing antibiotic duration for AOM and evaluated implementation and sustainability for the interventions. Methods: Costs associated with each implementation activity were recorded over time, including material/supply costs (eg, printing) and personnel time costs. Sustainability costs were estimated based on ongoing implementation expenses. For each system, we assessed total intervention, activity-specific, and sustainability costs. Aggregate results were reported as the median across systems. Results: The total median implementation costs were $3,606 (range $2,540-$4,672) for the low-intensity intervention and $9,203 (range $7,557-$10,849) for the high-intensity intervention. For the low-intensity intervention, the primary cost driver was electronic health record modifications totaling $2,292 (range $1,615-$2,968). For the high-intensity intervention, the primary cost driver was audit and feedback system activation totaling $5,597 (range $2,885-$8,309). Personnel time accounted for over 90% of costs in both study arms. Sustainability costs were $133/year (range $77-$190) for the low-intensity intervention and $764/year (range $628-$901) for the high-intensity intervention. Conclusions: Overall costs were low. The high-intensity intervention resulted in higher costs compared to the low-intensity intervention.