ABSTRACT
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 during the winter of 1996-1997 in France and Italy. All ear, nose, and throat (ENT) infections were described clinically; data on the consumption of medical items (physician visits, drug treatment, hospitalization, physiotherapy, 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 to 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 were 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 sites. Seven homogeneous groups of RP were found, 2 of them each representing <4% of the overall population. One group presented with otalgia, although the diagnosis of AOM was not recorded by the physician. In 4 groups, the presence of nasal discharge plus cough (without otalgia) was used to make the diagnosis. Medical item consumption varied by country and by group of RP, mainly in the prevailing choice of antibiotics. The difference in duration of treatment was not statistically significant. As a consequence, the costs of caring for patients with RP varied greatly, RP with AOM being the most costly. 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 months of age, had a history of AOM associated with effusion, or attended a community-based child care facility. Therefore, clinical trials aimed at demonstrating cost-effectiveness of prophylaxis should focus on this population.
