Is antibiotic prophylaxis for bacterial endocarditis cost-effective?

Area of Science:

• Cardiology
• Infectious Diseases
• Health Economics

Background:

• The American Heart Association (AHA) recommends antibiotic prophylaxis for bacterial endocarditis before certain dental procedures.
• The cost-effectiveness of this prophylactic antibiotic use remains unclear.
• This study aimed to assess the economic value of predental antibiotic prophylaxis in patients with heart disease.

Purpose of the Study:

• To estimate the cost-effectiveness of predental antibiotic prophylaxis.
• To compare various antibiotic regimens against a no-prophylaxis strategy.
• To identify optimal antibiotic choices for endocarditis prevention in dental settings.

Main Methods:

• A cost-effectiveness analysis was performed using a Markov model.
• Seven antibiotic regimens aligned with AHA guidelines were evaluated.
• A hypothetical cohort of 10 million patients at moderate or high risk for endocarditis was modeled.

Main Results:

• Clarithromycin prophylaxis cost $88,007 per quality-adjusted life year gained for moderate/high-risk patients.
• Amoxicillin and ampicillin prophylaxis led to a net loss of lives.
• Clarithromycin prophylaxis in 10 million individuals prevented 119 endocarditis cases and saved 19 lives.

Conclusions:

• Predental antibiotic prophylaxis is cost-effective solely for individuals at moderate or high risk of endocarditis.
• Amoxicillin and ampicillin are not cost-effective and should not be preferred agents.
• Clarithromycin is recommended as the drug of choice, with cephalexin as a viable alternative, necessitating guideline revision.