Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials.

Abstract

BACKGROUND:

Cellulitis (erysipelas) is a recurring and debilitating bacterial infection of the skin and underlying tissue. We assessed the cost-effectiveness of prophylactic antibiotic treatment to prevent the recurrence of cellulitis using low dose penicillin V in patients following a first episode (6 months prophylaxis) and more recurrent cellulitis (12 months prophylaxis, or 6 months in those declining 12 months).

METHODS:

Within-trial cost-effectiveness analysis was conducted using the findings of two randomised placebo-controlled multicentre trials (PATCH I and PATCH II), in which patients recruited in the UK and Ireland were followed-up for up to 3 years. Incremental cost, reduction in recurrence, cost per recurrence prevented and cost/QALY were estimated. National unit and reference costs for England in 2010 were applied to resource use, exploring NHS and societal perspectives. A total of 397 patients from the two trials contributed to the analysis.

RESULTS:

There was a 29% reduction in the number of recurrences occurring within the trial (IRR: 0.71 95%CI: 0.53 to 0.90, p = 0.02), corresponding to an absolute reduction of recurrence of 0.31 recurrences/patient (95%CI: 0.05 to 0.59, p = 0.02). Incremental costs of prophylaxis suggested a small cost saving but were not statistically significant, comparing the two groups. If a decision-maker is willing to pay up to £25,000/QALY then there is a 66% probability of antibiotic prophylaxis being cost-effective from an NHS perspective, rising to 76% probability from a secondary, societal perspective.

CONCLUSION:

Following first episode or recurrent cellulitis of the leg, prophylactic low dose penicillin is a very low cost intervention which, on balance, is effective and cost-effective at preventing subsequent attacks. Antibiotic prophylaxis reduces cellulitis recurrence by nearly a third but is not associated with a significant increase in costs.

• Authors: James M Mason, Kim S Thomas, Angela M Crook, Katharine A Foster, Joanne R Chalmers, Andrew J Nunn, Hywel C Williams
• Journal: PloS one (PLoS One) Vol. 9 Issue 2 Pg. e82694 ( 2014) ISSN: 1932-6203 [Electronic] United States
• PMID: 24551029 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents

Topics

• Aged
• Anti-Bacterial Agents (economics, pharmacology, therapeutic use)
• Antibiotic Prophylaxis (economics)
• Cellulitis (drug therapy, economics, prevention & control)
• Cost-Benefit Analysis
• Costs and Cost Analysis
• Female
• Humans
• Leg (pathology)
• Male
• Middle Aged
• Quality of Life
• Secondary Prevention
• Treatment Outcome