Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials.

Mason, James M.; Thomas, Kim; Crook, Angela M.; Foster, Katharine A.; Chalmers, Joanne; Nunn, Andrew J.; Williams, Hywel C.

Abstract

Background
Cellulitis (erysipelas) is a recurring and debilitating bacterial infection of the skin and underlying tissue. We assessed the cost-effectiveness of prophylactic antibiotic treatment to prevent the recurrence of cellulitis using low dose penicillin V in patients following a first episode (6 months prophylaxis) and more recurrent cellulitis (12 months prophylaxis, or 6 months in those declining 12 months).

Methods
Within-trial cost-effectiveness analysis was conducted using the findings of two randomised placebo-controlled multicentre trials (PATCH I and PATCH II), in which patients recruited in the UK and Ireland were followed-up for up to 3 years. Incremental cost, reduction in recurrence, cost per recurrence prevented and cost/QALY were estimated. National unit and reference costs for England in 2010 were applied to resource use, exploring NHS and societal perspectives. A total of 397 patients from the two trials contributed to the analysis.

Results
There was a 29% reduction in the number of recurrences occurring within the trial (IRR: 0.71 95%CI: 0.53 to 0.90, p = 0.02), corresponding to an absolute reduction of recurrence of 0.31 recurrences/patient (95%CI: 0.05 to 0.59, p = 0.02). Incremental costs of prophylaxis suggested a small cost saving but were not statistically significant, comparing the two groups. If a decision-maker is willing to pay up to £25,000/QALY then there is a 66% probability of antibiotic prophylaxis being cost-effective from an NHS perspective, rising to 76% probability from a secondary, societal perspective.

Conclusion
Following first episode or recurrent cellulitis of the leg, prophylactic low dose penicillin is a very low cost intervention which, on balance, is effective and cost-effective at preventing subsequent attacks. Antibiotic prophylaxis reduces cellulitis recurrence by nearly a third but is not associated with a significant increase in costs.

• Journal Article Type: Article
• Acceptance Date: Nov 4, 2013
• Online Publication Date: Feb 14, 2014
• Publication Date: Feb 14, 2014
• Deposit Date: Sep 17, 2018
• Publicly Available Date: Nov 19, 2018
• Journal: PLoS ONE
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 2
• Article Number: e82694
• DOI: https://doi.org/10.1371/journal.pone.0082694
• Public URL: https://nottingham-repository.worktribe.com/output/1097813
• PMID: 24551029