Tsevat J, Durand-Zaleski I, Pauker S G
Department of Medicine, Tufts University School of Medicine, Boston, MA 02111.
Am J Public Health. 1989 Jun;79(6):739-43. doi: 10.2105/ajph.79.6.739.
We performed a cost-effectiveness analysis to evaluate whether patients with artificial joints should take penicillin, erythromycin, or no antibiotics before dental procedures. We modeled the risk of anaphylaxis from penicillin, the risks and consequences of an artificial joint infection, and the actual variable costs of hospitalization and antibiotics. Penicillin prophylaxis is slightly less expensive than erythromycin prophylaxis but is both more expensive and less effective than no prophylaxis. Erythromycin prophylaxis, the most effective, is the most expensive strategy. The marginal cost effectiveness of erythromycin prophylaxis compared to no prophylaxis is $12,900 per quality-adjusted year of life saved. Sensitivity analysis demonstrates that the risk of developing a joint infection is the key parameter in the analysis. Based on our estimated risk of developing a joint infection, the cost-effectiveness of antibiotic prophylaxis with erythromycin compares favorably with other medical interventions. Thus, until a definitive study to quantify the risk is conducted, patients with artificial joints should take prophylactic erythromycin when they undergo dental procedures.
我们进行了一项成本效益分析，以评估人工关节患者在牙科手术前是否应服用青霉素、红霉素或不使用抗生素。我们对青霉素过敏反应的风险、人工关节感染的风险和后果以及住院和抗生素的实际可变成本进行了建模。青霉素预防措施比红霉素预防措施略便宜，但比不进行预防既更昂贵又效果更差。红霉素预防措施是最有效的，但也是最昂贵的策略。与不进行预防相比，红霉素预防措施的边际成本效益为每挽救一个质量调整生命年12,900美元。敏感性分析表明，发生关节感染的风险是该分析中的关键参数。根据我们估计的发生关节感染的风险，红霉素抗生素预防措施的成本效益与其他医疗干预措施相比具有优势。因此，在进行定量风险的确定性研究之前，人工关节患者在接受牙科手术时应服用预防性红霉素。
