Infective endocarditis: prevention: antibiotic prophylaxis for dental extractions in high-risk patients was cost-effective.

Clinical bottom line (level 1b)

  1. Antibiotic prophylaxis to prevent infective endocarditis in high risk patients undergoing dental extraction saved money.
Gould et al: British Heart Journal 1993; 70: 79-83
Expires July 2003

The study

cost-effectiveness analysis
Setting: National Health Service, UK

patients considered at high risk for infective endocarditis having dental procedures

  • Viewpoint: third party, eg. HMO or NHS purchaser
  • Benefit assessment: developing infective endocarditis, death, anaphylactic reaction to penicillin taken from published data, or local data if unavailable
  • Resources and costs: costs calculated from inspecting the notes of 63 patients with infective endocarditis (Grampian region, 1980 to 1990). 6% discount per year cost adjustment
  • Sensitivity analysis: varied cost of treatment, incidence of infective endocarditis and penicillin anaphylaxis

    • The evidence

    intervention cost
    gross savings attributable to prophylaxis 28.96 GBP
    cost of prophylaxis 2.36 GBP
    cost of treating reactions to antibiotics 0.20 GBP
    net savings attributable to prophylaxis 26.40 GBP

    Effect of sensitivity analysis: no change following sensitivity analysis
    • The estimates of the hospital costs of treating endocarditis were 3392 GBP for a fatality and 11, 831 GBP for a survivor (at 1991/1992 prices).
    • The estimates of number of cases of infective endocarditis a year in UK were based on OPCS statistics for deaths from infective endocarditis both mentioned and inferred. This may give a high estimate than normally quoted.
    • Data suggested NNT=1800 to prevent one death, and NNT=440 to prevent one case of non-fatal infective endocarditis.

    Citation

    1. Gould , et al: Cost effectiveness if prophylaxis in dental practice to prevent infective endocarditis. British Heart Journal 1993; 70: 79-83
    Search Terms: infective endocarditis, prophylaxis and cost effectiveness
    Contributor: Sumit Dhingra, Carl Heneghan and Chris Ball, July 2000
    Reviewer:

    Clinical Question.
    Patient infective endocarditis
    Intervention or Exposure antibiotic prophylaxis
    Outcome cost-effectiveness