Antibiotic prescription for acute sinusitis in otherwise healthy adults. Clinical cure in relation to costs.
OBJECTIVE
To determine which treatment strategy offers the most cost-effective option in managing acute sinusitis.


METHODS
The modelling procedure included five clinical strategies, varying from "wait and see for a week", to "prescribing antibiotics selectively" to "prescribing antibiotics immediately" and to "performing further diagnostics".


METHODS
Outpatient clinics and primary health care.


METHODS
Data were derived from clinical trials that included otherwise healthy patients with acute sinusitis.


METHODS
The marginal cost-effectiveness.


RESULTS
By using the strategy "wait and see for a week", 91.5% of the patients, by "prescribing antibiotics selectively", 93.2%, of the patients, and by "prescribing antibiotics immediately", 94.5% of the patients were cured after a 1-week period. The costs for curing one additional patient were Dutch Florin (DFL) 516 when antibiotics were selectively prescribed, and DFL 882 when antibiotics were immediately prescribed. Further diagnostic procedures did not improve outcome in terms of marginal cost-effectiveness.


CONCLUSIONS
In patients presenting with acute sinusitis, postponing antibiotics for 1 week is the most cost-effective strategy.
de Bock
G H
GH
Department of Medical Decision Making, Leiden University Medical Centre, The Netherlands.
van Erkel
A R
AR
Springer
M P
MP
Kievit
J
J
D000208:Acute Disease / Q000191:economics; D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004363:Drug Utilization / Q000191:economics; D005194:Family Practice / Q000191:economics / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics
D000900:Anti-Bacterial Agents