Antibiotic Prophylaxis Cost-Effective to Prevent Infective Endocarditis

Using antibiotic prophylaxis to prevent ineffective endocarditis is cost-effective for patients at risk and especially cost-effective among patients with a high risk, according to a presentation at the American Heart Association 2016 Scientific Sessions.

“In March 2008, the National Institute for Health and Care Excellence (NICE) recommended stopping antibiotic prophylaxis for those at risk of infective endocarditis undergoing dental procedures in the UK, citing a lack of efficacy and cost-effectiveness,” Matthew Franklin, PhD, MSc, of the School of Health and Related Research at the University of Sheffield in the United Kingdom, and colleagues wrote. “We performed a new health economic evaluation comparing ‘antibiotic prophylaxis’ to ‘no antibiotic prophylaxis’ using present-day estimates of efficacy, adverse events, and resource use.”

The researchers used a decision analytic cost-effectiveness model to determine the cost-effectiveness of antibiotic prophylaxis among patients at risk for ineffective endocarditis. They used quality adjusted life years (QALYs) as a measurement for health service costs. In order to compare “antibiotic prophylaxis” to “no antibiotic prophylaxis,” they analyzed rates of ineffective endocarditis from before NICE guidance to rates of ineffective endocarditis after the NICE guidance was implemented. Adverse events and mortality were gathered using recent data, and health resource utilization data were based on UK hospital episode statistics.

Results of the analysis showed that use of antibiotic prophylaxis was both more cost-effective and more effective than not using antibiotic prophylaxis. They noted that these findings are variable based on the efficacy of antibiotic prophylaxis; however, antibiotic prophylaxis would have to be significantly ineffective to lose cost-effectiveness. 

Study results found that use of antibiotic prophylaxis was associated with an annual cost savings of £5.3 million to £7.9 million. The researchers also stated that health gains of more than 2500 QALYs could be gained if the UK reinstated use of antibiotic prophylaxis.

“These findings support the cost-effectiveness of guidelines recommending antibiotic prophylaxis use in high-risk individuals, such as recommended in current American Heart Association and European Society of Cardiology guidelines,” Dr Franklin and colleagues concluded. —David Costill