{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:55:58Z","timestamp":1777683358993,"version":"3.51.4"},"reference-count":24,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2014,7,29]],"date-time":"2014-07-29T00:00:00Z","timestamp":1406592000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Health Serv Res Policy"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate unwarranted variation in ventilation tube insertions for otitis media with effusion in children in England. This procedure is known to be \u2018overused\u2019 from clinical audits, as only one in three ventilation tube insertions conforms to the appropriateness criteria of the National Institute for Health and Care Excellence (NICE); but audits cannot identify the scale of \u2018underuse\u2019 \u2013 i.e. patients who would benefit but are not treated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>To explore both \u2018underuse\u2019 and \u2018overuse\u2019 of ventilation tubes for otitis media with effusion, we developed an epidemiological model based on: definitions of children with otitis media with effusion expected to benefit from ventilation tubes according to NICE guidance; epidemiological and clinical information from a systematic review; and expert judgement. A range of estimates was derived using Monte Carlo simulation and compared with the number of ventilation tubes provided in the English National Health Service in 2010.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>About 32,200 children in England would be expected to benefit from ventilation tubes for otitis media with effusion per year (between 20,411 and 45,231 with 90% certainty). The observed number of ventilation tubes for otitis media with effusion-associated diagnoses was 16,824.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The expected population capacity to benefit from ventilation tubes for otitis media with effusion based on NICE guidance appeared to exceed, by far, the number of ventilation tubes provided in the English National Health Service. So, while there is known \u2018overuse\u2019, there also may be substantial \u2018underuse\u2019 of ventilation tubes for otitis media with effusion if NICE criteria were applied. Future investigations of unwarranted variation should, therefore, not only focus on the patients who are treated but also consider the potential for benefit at the population level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1355819614536886","type":"journal-article","created":{"date-parts":[[2014,7,29]],"date-time":"2014-07-29T23:37:38Z","timestamp":1406677058000},"page":"236-244","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Using an epidemiological model to investigate unwarranted variation: the case of ventilation tubes for otitis media with effusion in England"],"prefix":"10.1177","volume":"19","author":[{"given":"Laura","family":"Schang","sequence":"first","affiliation":[{"name":"Doctoral Student, Department of Management, London School of Economics and Political Science, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"De Poli","sequence":"additional","affiliation":[{"name":"Research Assistant, Department of Management, London School of Economics and Political Science, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mara","family":"Airoldi","sequence":"additional","affiliation":[{"name":"Fellow, Department of Management, London School of Economics and Political Science, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alec","family":"Morton","sequence":"additional","affiliation":[{"name":"Professor of Management Science, Department of Management Science, Strathclyde Business School, University of Strathclyde, Scotland, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Bohm","sequence":"additional","affiliation":[{"name":"Clinical Academic Lecturer, Ear Institute, University College London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Lakhanpaul","sequence":"additional","affiliation":[{"name":"Professor of Integrated Community Child Health, General and Adolescent Paediatrics Unit, UCL Institute of Child Health, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Schilder","sequence":"additional","affiliation":[{"name":"NIHR Research Professor and Professor of Paediatric Otorhinolaryngology, Ear Institute, University College London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gwyn","family":"Bevan","sequence":"additional","affiliation":[{"name":"Professor of Policy Analysis, Department of Management, London School of Economics and Political Science, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2014,7,29]]},"reference":[{"key":"bibr1-1355819614536886","volume-title":"Health policy responses to the financial crisis in Europe","author":"Mladovsky P","year":"2012"},{"key":"bibr2-1355819614536886","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2013.08.002"},{"key":"bibr3-1355819614536886","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f3668"},{"key":"bibr4-1355819614536886","volume-title":"Reducing spending on low clinical value treatments","author":"Audit Commission","year":"2011"},{"key":"bibr5-1355819614536886","volume-title":"Crossing the quality chasm","author":"Institute of Medicine","year":"2001"},{"key":"bibr6-1355819614536886","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-349-20781-7_7"},{"key":"bibr7-1355819614536886","doi-asserted-by":"publisher","DOI":"10.1177\/014107688507800809"},{"key":"bibr8-1355819614536886","unstructured":"NHS Right Care. 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