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-effe ctive option in managing acute sinusitis. Design - The modelling procedure included five clinical strategies, varying from "wait and see for a week", to "prescribing antibiotics selectively" t o "prescribing antibiotics immediately" and to "performing further diagnost ics". Setting - Outpatient clinics and primary health care. Patients - Data were derived from clinical trials that included otherwise h ealthy patients with acute sinusitis. Main outcome measures - The marginal cost-effectiveness. Results - By using the strategy "wait and see for a week", 91.5% of the pat ients, 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 Du tch Florin (DFL) 516 when antibiotics were selectively prescribed, and DPL 882 when antibiotics were immediately prescribed. Further diagnostic proced ures did not improve outcome in terms of marginal cost-effectiveness. Conclusions - In patients presenting with acute sinusitis, postponing antib iotics for 1,week is the most cost-effective strategy.