Rb. Devereux et al., COST-EFFECTIVENESS OF INFECTIVE ENDOCARDITIS PROPHYLAXIS FOR MITRAL-VALVE PROLAPSE WITH OR WITHOUT A MITRAL REGURGITANT MURMUR, The American journal of cardiology, 74(10), 1994, pp. 1024-1029
To assess the cost-effectiveness of prevention of infective endocardit
is (IE) and to calculate cost-effectiveness of currently recommended r
egimens in patients with mitral valve prolapse (MVP), data on risk of
death, complications, and health-care use, and cumulative incremental
health-care costs due to the occurrence of IE were combined with data
on the prevalence and manifestations of MVP, estimated years of life l
ost, and efficacy of antibiotic prophylaxis. Effectiveness and costs o
f standard endocarditis prophylaxis regimens were calculated per IE ca
se prevented and years of life saved. Under the most likely scenario,
oral amoxicillin prophylaxis for all MVP patients would prevent 32 cas
es of IE per million dental procedures at approximate costs of $119,00
0 per prevented case and $21,000 per year of life saved. limiting prop
hylaxis to patients with mitral murmurs would prevent 80 cases of IE p
er million procedures at costs of about $19,000 per prevented case and
$3,000 per year of life saved. Erythromycin prophylaxis was slightly
less expensive than amoxicillin per benefit because of lower cost and
lack of drug anaphylaxis, whereas intravenous ampicillin was 7 to 30 t
imes more costly. Sensitivity analyses suggested that erythromycin pro
phylaxis might be cost-saving under some scenarios, whereas intravenou
s ampicillin use might cause net loss of life. Thus, prevention with o
ral antibiotics of the cumulative morbidity and incremental health car
e costs due to IE in MVP patients is reasonably cost-effective for MVP
patients with mitral murmurs.