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Economic evaluation of antibacterials in the treatment of acute sinusitis
C Laurier1, J Lachaine, M Ducharme
1Faculty of Pharmacy, Université de Montréal, Québec, Canada. lauriercere.umontreal.ca
Objective:
The objective of this study was to compare costs, efficacy and cost efficacy of alternate oral antibacterial regimens for the ambulatory treatment of acute sinusitis. A public third-party perspective was adopted.
Design:
The analysis was based on a decision tree and considered the episode of care from the decision to initiate an antibacterial until the end of the first course of treatment or the end of a subsequent course of treatment when needed. Efficacy data were retrieved from published clinical trials. Direct medical costs included the costs of physician visits, diagnostic tests and medications.
Setting:
The study pertained to adults treated in a primary-care setting in the Canadian province of Québec.
Interventions:
The antibacterials studied were amoxicillin, amoxicillin/clavulanate, azithromycin, cefaclor, cefuroxime axetil and clarithromycin.
Main Outcome Measures And Results:
The main outcome measured was the proportion of patients showing resolution or improvement of their symptoms. Initiating a treatment with amoxicillin was associated with similar efficacy and lower overall costs when compared with the other antibacterials. Low dosages of clarithromycin and azithromycin followed amoxicillin in terms of cost-efficacy ratio.
Conclusions:
This study confirms the place of amoxicillin as a first choice agent for acute sinusitis, with low dose clarithromycin and azithromycin as second choices.