COMPARATIVE COST-ANALYSIS OF MYRINGOTOMY WITH INSERTION OF VENTILATION TUBES IN ONTARIO AND BRITISH-COLUMBIA

Objective: The purpose of this study was to conduct a comparative cost analysis of myringotomy with insertion of ventilation tube (MVT) for children performed at two regional paediatric centres: The Hospital fo r Sick Children, and the British Columbia Children's Hospital. Design: Comparative cost analysis. Setting: The Hospital for Sick Children (H SC), Toronto, and the British Columbia Children's Hospital (BCCH), Van couver. Methods: The cost analysis was performed from a health system perspective using a treatment protocol developed through a review of t he literature and input from staff from each of the study hospitals. M VT cost estimates were derived, including direct treatment costs and o verhead costs. Results: Total costs per MVT case (in 1994 Canadian dol lars: Cdn$ 1.00 approximate to US$ 0.75) varied from $390.81 at BCCH t o $455.63 at HSC. Regional variations in physician costs accounted for almost 70% of the difference in MVT case costs. The distribution of n onphysician MVT case costs were similar in each study hospital, with d irect (nonphysician) surgical costs, preoperative assessment and recov ery room costs, and administration accounting for 30%, 26%, and 44% of total nonphysician costs, respectively. Conclusions: This study ident ified the magnitude and determinants of regional variations in the cos t of MVT surgery. Such cost estimates serve as an important (but not t he sole) ingredient in service cost-effectiveness deliberations and in the formulation of evidence-based care when health care resources are scarce.