Cost-effectiveness analysis for SilAtro-5-90 adjuvant treatment in the management of recurrent tonsillitis, compared with usual care only.

Autor: Ostermann T; Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany. Thomas.Ostermann@uni-wh.de., Park AL; Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK., De Jaegere S; Deutsche Homöopathie-Union, DHU-Arzneimittel GmbH & Co. KG, Ottostraße 24, 76227, Karlsruhe, Germany., Fetz K; Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany., Klement P; Deutsche Homöopathie-Union, DHU-Arzneimittel GmbH & Co. KG, Ottostraße 24, 76227, Karlsruhe, Germany., Raak C; Institute of Integrative Medicine, Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany., McDaid D; Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
Jazyk: angličtina
Zdroj: Cost effectiveness and resource allocation : C/E [Cost Eff Resour Alloc] 2021 Sep 19; Vol. 19 (1), pp. 60. Date of Electronic Publication: 2021 Sep 19.
DOI: 10.1186/s12962-021-00313-4
Abstrakt: Purpose: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
(© 2021. The Author(s).)
Databáze: MEDLINE
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