Abstract 15628: The Use of Antibiotic Prophylaxis to Prevent Infective Endocarditis is Cost Effective
Introduction: In March 2008, the National Institute for Health and Care Excellence (NICE) recommended stopping antibiotic prophylaxis (AP) for those at risk of infective endocarditis (IE) undergoing dental procedures in the UK, citing a lack of efficacy and cost-effectiveness. We performed a new health economic evaluation comparing ‘AP’ to ‘No AP’ using present-day estimates of efficacy, adverse events and resource-use.
Methods: A decision analytic cost-effectiveness model was used. Health service costs and benefits were measured as Quality Adjusted Life Years (QALYs). Rates of IE before and after the NICE guidelines were used to estimate AP efficacy. AP adverse event rates (congestive heart failure, valve replacement, AP side effects and mortality) were derived from recent UK data and resource implications (hospitalisation, outpatient and primary care, and medications) were based on national Hospital Episode Statistics.
Results: AP was less costly and more effective than no AP for all patients at risk of IE. The results are sensitive to AP efficacy, but efficacy would have to be substantially lower for AP not to be cost-effective. AP was even more cost-effective in patients at high-risk of IE. Only a marginal reduction in annual IE rates (1·56 cases, high-risk; 35 cases, all-at-risk) would be required for AP to be considered cost-effective at £20,000 ($28,381/є25,166) per QALY. Annual cost savings of £5·3-7·9m ($7.5-11.2m/є6.7-9.9m) and health gains >2,500 QALYs could be gained from reinstating AP in England. A conservative expected value of perfect information (EVPI) estimate was £25.9m ($36.8m/є32.6m) when uncertainty around AP efficacy was increased. This indicates that any randomised controlled trial costing <£25.9m ($36.8m/є32.6m) would be cost-effective because of the value of the reduced uncertainty about the benefits of AP that would result.
Conclusions: AP is cost-effective for preventing IE, particularly in those at high-risk of IE. These findings support the cost-effectiveness of guidelines recommending AP use in high-risk individuals, such as recommended in current American Heart Association and European Society of Cardiology guidelines.
Author Disclosures: M. Franklin: None. A. Wailoo: None. M.J. Dayer: None. S. Jones: None. B. Prendergast: None. L.M. Baddour: None. P.B. Lockhart: None. M.H. Thornhill: None.
- © 2016 by American Heart Association, Inc.