Ostermann Thomas, Park A-La, De Jaegere Sabine, Fetz Katharina, Klement Petra, Raak Christa, McDaid David
Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
Cost Eff Resour Alloc. 2021 Sep 19;19(1):60. doi: 10.1186/s12962-021-00313-4.
Antibiotics are one possible treatment for patients with recurrent acute throat infections (ATI), but effectiveness can be modest. In view of worries over antibiotic resistance, treatment pathways that reduce recurrence of ATI are essential from a public health perspective. Integrative treatment strategies can be an option but there is still a high demand to provide evidence of their cost effectiveness.
We constructed a 4-state Markov model to compare the cost-effectiveness of SilAtro-5-90 as adjuvant homeopathic therapy to care as usual with care as usual alone in reducing the recurrence of ATI for children and adults with suspected moderate recurrent tonsillitis. The analysis was performed from a societal perspective in Germany over a 2-year period. Results are reported separately for children < 12 and for individuals aged 12 and over. The model draws on evidence from a multi-centre randomised clinical trial that found this strategy effective in reducing recurrence of ATI. Costs in 2019 € and outcomes after 1 year are discounted at a rate of 3% per annum.
For adults and adolescents aged 12 years and over, incremental cost per ATI averted in the adjuvant therapy group was €156.64. If individuals enter the model on average with a history of 3.33 previous ATIs, adjuvant therapy has both lower costs and better outcomes than care as usual. For children (< 12 years) adjuvant therapy had both lower costs and ATI than care as usual. The economic case is stronger if adjuvant treatment reduces surgical referral. At a hypothetical cost per ATI averted threshold of €1000 probabilistic sensitivity analysis suggests Silatro-5-90 has a 65% (adults) and 71% (children) chance of being cost-effective.
Our results indicate the importance of considering homeopathy as adjuvant therapy in the treatment of ATIs in individuals with recurrent tonsillitis from a socio-economic perspective. Further evaluation should assess how differences in uptake and sustained use of homeopathic adjuvant therapy, as well as changing patterns of antibiotic prescribing, impact on cost effectiveness.
抗生素是复发性急性咽喉感染（ATI）患者的一种可能治疗方法，但疗效可能一般。鉴于对抗生素耐药性的担忧，从公共卫生角度来看，减少ATI复发的治疗途径至关重要。综合治疗策略可能是一种选择，但仍迫切需要提供其成本效益的证据。
我们构建了一个四状态马尔可夫模型，以比较SilAtro - 5 - 90作为辅助顺势疗法与单纯常规护理相比，在降低疑似中度复发性扁桃体炎儿童和成人的ATI复发方面的成本效益。分析是从德国社会角度在两年期间进行的。结果分别报告12岁以下儿童和12岁及以上个体的情况。该模型借鉴了一项多中心随机临床试验的证据，该试验发现该策略在降低ATI复发方面有效。2019年欧元成本和1年后的结果按每年3%的贴现率进行贴现。
对于12岁及以上的成年人和青少年，辅助治疗组中每避免一次ATI的增量成本为156.64欧元。如果个体平均有3.33次既往ATI病史进入模型，辅助治疗比常规护理成本更低且效果更好。对于12岁以下儿童，辅助治疗的成本和ATI发生率均低于常规护理。如果辅助治疗减少手术转诊，经济理由则更强。在假设每避免一次ATI的成本阈值为1000欧元时，概率敏感性分析表明Silatro - 5 - 90具有65%（成年人）和71%（儿童）具有成本效益的可能性。
我们的结果表明，从社会经济角度来看，在复发性扁桃体炎个体的ATI治疗中考虑顺势疗法作为辅助治疗的重要性。进一步评估应评估顺势疗法辅助治疗的采用和持续使用差异以及抗生素处方模式的变化如何影响成本效益。
