Use of diagnostic clusters to assess the economic consequences of rhinopharyngitis in children in Italy and France during the winter

To determine how practitioners diagnose rhinopharyngitis (RP), we conducted a longitudinal, multicenter study of a cohort of 900 children, collecting medical and economic data without interfering with usual medical practice d uring the winter of 1996-1997 in France and Italy. All ear, nose, and throa t (ENT) infections were described clinically; data on the consumption of me dical items (physician visits, drug treatment, hospitalization, physiothera py, preventive treatment, laboratory tests, roentgenograms, and outpatient procedures) were collected to estimate the cost of caring for patients with RP. The mean age of the children was 28.0 months, and the ratio of males t o females was approximately 5 to 4. Patients had had a mean 4.1 episodes of RP the previous year and 1.4 episodes of acute otitis media (AOM). There w ere no marked differences in the children's characteristics between France and Italy. During the winter of the study, this population experienced 4.26 episodes of ENT infection, of which 73.5% were documented at the study sit es. Seven homogeneous groups of RP were found, 2 of them each representing <4% of the overall population. One group presented with otalgia, although t he diagnosis of AOM was not recorded by the physician. In 4 groups, the pre sence of nasal discharge plus cough (without otalgia) was used to make the diagnosis. Medical item consumption varied by country and by group of RP, m ainly in the prevailing choice of antibiotics. The difference in duration o f treatment was not statistically significant. As a consequence, the costs of caring for patients with RP varied greatly, RP with AOM being the most c ostly. Last, prognostic factors for costly episodes of infectious ENT were identified. The population at risk included young children who had had AOM episodes during the previous winter, had a first episode of AOM before 6 mo nths of age, had a history of AOM associated with effusion, or attended a c ommunity-based child care facility. Therefore, clinical trials aimed at dem onstrating cost-effectiveness of prophylaxis should focus on this populatio n.