Table 1.

Cost and Probability Parameters to Populate the Decision Tree

Parameter Type	Parameter (applicable CPT code)	Sourcea	Point Estimateb	Lower Bound	Upper Bound	Distribution Type
Cost	Initial Physician’s Office Consultation (92004)	8	$131	----	----	----
	Antibiotic for Children Receiving Deferred Surgery (tobramycin sulfate 0.3%)	c	$16	----	----	----
	Office Procedure: Professional Fee & Procedure Reimbursement (68810)	8	$198	----	----	----
	Post Procedure Steroidal Antibiotic (tobramycin - dexamethasone 0.1%)	c	$74	----	----	----
	Established Patient Office Visit (99213)	8	$63	----	----	----
	Anesthesia for Facility Surgery	8	$250	----	----	----
	Facility Surgery Professional Fee (68811) (initial surgery)	9	$172	----	----	----
	Facility Surgery Professional Fee (68811,68815,68816) (secondary surgery)	9	$208	----	----	----
	Ambulatory Surgery Center Facility Fee (initial surgery)	8	$607	----	----	----
	Ambulatory Surgery Center Facility Fee (secondary surgery)	d	$681	----	----	----
	Hospital Outpatient Department Facility Fee (initial surgery)	8	$1276	----	----	----
	Hospital Outpatient Department Facility Fee (secondary surgery)	e	$1408	----	----	----
Probability	Success of Immediate Office Surgery	f	0.75	0.66	0.82	PERT
	Spontaneous resolution after Immediate Office Surgery and Prior to Retreatment	Consensus	0.03	0.02	0.04	PERT
	Failure to Present for Repeat Surgery After Initial Office Failure	Consensus	0.05	0.03	0.07	PERT
	Success of Office Surgery After Initial Office Failure	11	0.56	0.33	0.76	PERT
	Repeat Office Surgery After Initial Office Failure	Consensus	0.10	0.05	0.15	PERT
	Success of Repeat Surgery After Initial Surgery Failure	g	0.78	0.71	0.83	PERT
	Spontaneous Resolution Prior to Deferred Facility Surgery	Consensus	0.75	0.5	0.9	Calculated
	Children Resolving who Resolve Before Antibiotic Prescription Renewal	Consensus	0.5	0.4	0.6	PERT
	Children Who Reach Date of Scheduled Surgery with a Return Clinic Visit	Consensus	0.5	----	----	----
	Children Scheduled for Deferred Surgery Not Presenting	Consensus	0.05	0.03	0.07	PERT
	Spontaneous Resolution Between 15 and 18 Months	Consensus	0.02	0.01	0.03	PERT
	Facility Surgeries at Ambulatory Surgery Center	7	0.32	0.3	1	PERT
	Facility Surgeries at Hospital	7	0.68	0.0	1	PERT
	Success of Initial Facility Surgery	7	0.80	0.74	0.85	PERT
	Failure to Present for Repeat Facility Surgery After Facility Failure	Consensus	0.05	0.03	0.07	PERT

CPT = Current Procedural Terminology (copyright American Medical Association, 2009)

PERT = Program Evaluation and Review Technique

^aNumbers represent reference numbers.

^bPoint estimates for costs are given in US dollars.

^cCost of drug at www.drugstore.com accessed August 8, 2009

^dBased on Medicare Physician Fee Schedule 20099 ambulatory surgery centers costs estimating that the distribution of type of surgery would approximate that found in a prospective observational study of secondary procedures: balloon catheter dilation ($780) in 43% of cases, nasolacrimal intubation ($607) in 45%, and repeat probing ($607) in 12%.10, 11

^eBased on Medicare Physician Fee Schedule 20099 hospital outpatient department costs estimating that the distribution of type of surgery would approximate that found in a prospective observational study of secondary procedures: balloon catheter dilation ($1582 including $306 cost of balloon catheter) in 43% of cases, nasolacrimal intubation ($1276) in 45%, and repeat probing ($1276) in 12%10, 11

^fData from unpublished subset of data published by PEDIG in 20087

^gBased on the success rates reported in an prospective observational study of secondary procedures -- balloon catheter dilation (77%), nasolacrimal intubation (84%) and repeat probing (56%) -- weighted according to the distribution of procedures in the study (43% of patients received balloon catheter dilation, 45% received nasolacrimal intubation, and 12% received repeat probing). The confidence interval is also based on the weighted data.10, 11