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

<h4>Background</h4>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 follow...

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Autores principales:	James M Mason, Kim S Thomas, Angela M Crook, Katharine A Foster, Joanne R Chalmers, Andrew J Nunn, Hywel C Williams
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/61adb22c1ff34c5e9f4a4c82dbb91fbd
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spelling	oai:doaj.org-article:61adb22c1ff34c5e9f4a4c82dbb91fbd2021-11-18T08:32:32ZProphylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials.1932-620310.1371/journal.pone.0082694https://doaj.org/article/61adb22c1ff34c5e9f4a4c82dbb91fbd2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24551029/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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).<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.James M MasonKim S ThomasAngela M CrookKatharine A FosterJoanne R ChalmersAndrew J NunnHywel C WilliamsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 2, p e82694 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q James M Mason Kim S Thomas Angela M Crook Katharine A Foster Joanne R Chalmers Andrew J Nunn Hywel C Williams Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials.
description	<h4>Background</h4>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).<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
format	article
author	James M Mason Kim S Thomas Angela M Crook Katharine A Foster Joanne R Chalmers Andrew J Nunn Hywel C Williams
author_facet	James M Mason Kim S Thomas Angela M Crook Katharine A Foster Joanne R Chalmers Andrew J Nunn Hywel C Williams
author_sort	James M Mason
title	Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials.
title_short	Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials.
title_full	Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials.
title_fullStr	Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials.
title_full_unstemmed	Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials.
title_sort	prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the patch i & ii trials.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/61adb22c1ff34c5e9f4a4c82dbb91fbd
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Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials.

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