title: Cost-Effectiveness of Decision Support Strategies in Acute Bronchitis.
abstract: BACKGROUND
  A recent clinical trial suggests that printed (PDS) and computer decision support (CDS) interventions are safe and effective in reducing antibiotic use in acute bronchitis relative to usual care (UC).
  
  
  OBJECTIVE
  Our aim was to evaluate the cost-effectiveness of decision support interventions in reducing antibiotic use in acute bronchitis.
  
  
  METHODS
  We conducted a clinical trial-based cost-effectiveness analysis comparing UC, PDS and CDS for management of acute bronchitis. We assumed a societal perspective, 5-year program duration and 30-day time horizon.
  
  
  METHODS
  The U.S. population aged 13-64 years presenting with acute bronchitis in the ambulatory setting.
  
  
  METHODS
  Printed and computer decision support interventions relative to usual care.
  
  
  METHODS
  Cost per antibiotic prescription safely avoided.
  
  
  RESULTS
  In the base case, PDS dominated UC and CDS, with lesser total costs (PDS: $2,574, UC: $2,768, CDS: $2,805) and fewer antibiotic prescriptions (PDS: 3.79, UC: 4.60, CDS: 3.95) per patient over 5 years. In one-way sensitivity analyses, PDS dominated UC across all parameter values, except when antibiotics reduced work loss by ≥ 1.9 days or the probability of hospitalization within 30 days was ≥ 0.9 % in PDS (base case: 0.2 %) or ≤ 0.4 % in UC (base case: 1.0 %). The dominance of PDS over CDS was sensitive both to probability of hospitalization and plausible variation in the adjusted odds of antibiotic use in both strategies.
  
  
  CONCLUSIONS
  A PDS strategy to reduce antibiotic use in acute bronchitis is less costly and more effective than both UC and CDS strategies, although results were sensitive to variation in probability of hospitalization and the adjusted odds of antibiotic use. This simple, low-cost, safe, and effective intervention would be an economically reasonable component of a multi-component approach to address antibiotic overuse in acute bronchitis.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. cmichaelidis@partners.org.
authors.forename: Constantinos I
authors.initials: CI
authors.lastname: Michaelidis
authors.affiliation: Institute for Advanced Application, Geisinger Health System, Danville, PA, USA.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Kern
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000379:methods; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D001991:Bronchitis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000379:methods*; D003661:Decision Support Techniques; D004360:Drug Therapy, Computer-Assisted / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008402:Mass Media / Q000191:economics*; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: acute bronchitis; antibiotics; cost effectiveness; decision support
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