Is antibiotic prophylaxis for bacterial endocarditis cost-effective? Med Decis Making 2005;25(3):308-20
Date
06/14/2005Pubmed ID
15951458DOI
10.1177/0272989X05276852Scopus ID
2-s2.0-18844456290 (requires institutional sign-in at Scopus site) 59 CitationsAbstract
BACKGROUND: Antibiotic prophylaxis for bacterial endocarditis is recommended by the American Heart Association (AHA) before undergoing certain dental procedures. Whether such antibiotic prophylaxis is cost-effective is not clear. The authors' objective is to estimate the cost-effectiveness of predental antibiotic prophylaxis in patients with underlying heart disease.
METHODS: The authors conducted a cost-effectiveness analysis using a Markov model to compare cost-effectiveness of 7 antibiotic regimens per AHA guidelines and a no prophylaxis strategy. The study population consisted of a hypothetical cohort of 10 million patients with either a high or moderate risk for developing endocarditis.
RESULTS: Prophylaxis for patients with moderate or high risk for endocarditis cost $88,007/quality-adjusted life years saved if clarithromycin was used. Prophylaxis with amoxicillin and ampicillin resulted in a net loss of lives. All other regimens were less cost-effective than clarithromycin. For 10 million persons, clarithromycin prophylaxis prevented 119 endocarditis cases and saved 19 lives.
CONCLUSION: Predental antibiotic prophylaxis is cost-effective only for persons with moderate or high risk of developing endocarditis. Contrary to current recommendations, our data demonstrate that amoxicillin and ampicillin are not cost-effective and should not be considered the agents of choice. Clarithromycin should be considered the drug of choice and cephalexin as an alternative drug of choice. The current published guidelines and recommendations should be revised.
Author List
Agha Z, Lofgren RP, VanRuiswyk JVMESH terms used to index this publication - Major topics in bold
AdultAmerican Heart Association
Antibiotic Prophylaxis
Cost-Benefit Analysis
Decision Support Techniques
Endocarditis, Bacterial
Female
Heart Diseases
Humans
Male
Markov Chains
Oral Surgical Procedures
Periodontics
Quality-Adjusted Life Years
Risk Assessment
Risk Factors
Software
Survival Analysis
Treatment Outcome