Cost-effectiveness of longer-term versus shorter-term provision of antibiotics in patients with persistent symptoms attributed to Lyme disease
| Autor: | Eddy M. M. Adang, Michiel L. Vogelaar, Henriët van Middendorp, Andrea W M Evers, Lisette Nieuwenhuis, Fidel J. Vos, Mirjam Tromp, Hadewych J. M. ter Hofstede, A. Rogier T. Donders, Anneleen Berende, Bart Jan Kullberg |
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| Přispěvatelé: | RS: CAPHRI - R5 - Optimising Patient Care, Epidemiologie, Promovendi PHPC |
| Rok vydání: | 2018 |
| Předmět: |
Male
Bacterial Diseases 0301 basic medicine Time Factors Economics Cost effectiveness Cost-Benefit Analysis lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] Social Sciences lcsh:Medicine Pathology and Laboratory Medicine ECONOMIC-EVALUATION GUIDELINES THERAPY law.invention 0302 clinical medicine DESIGN Randomized controlled trial Antibiotics law Clarithromycin Medicine and Health Sciences Medicine 030212 general & internal medicine lcsh:Science Cognitive Impairment Lyme Disease Multidisciplinary Antimicrobials Cognitive Neurology Ceftriaxone Drugs Middle Aged Anti-Bacterial Agents Bacterial Pathogens Treatment Outcome Infectious Diseases Neurology Medical Microbiology Doxycycline Drug Therapy Combination Female Quality-Adjusted Life Years Pathogens Hydroxychloroquine Research Article medicine.drug medicine.medical_specialty Cognitive Neuroscience Cost-Effectiveness Analysis DURATION 030106 microbiology CONTROLLED-TRIAL DIAGNOSIS Placebo Microbiology Drug Administration Schedule Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] 03 medical and health sciences Health Economics Pharmacotherapy Double-Blind Method Rheumatology Microbial Control Internal medicine MANAGEMENT Humans Microbial Pathogens Pharmacology Bacteria business.industry Borrelia Other Research Radboud Institute for Health Sciences [Radboudumc 0] lcsh:R Organisms Biology and Life Sciences Borrelia Infection Economic Analysis Quality-adjusted life year Health Care BORRELIOSIS lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] Antibiotic Resistance HEALTH-CARE Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5] Cognitive Science lcsh:Q Antimicrobial Resistance business Follow-Up Studies Neuroscience |
| Zdroj: | PLoS ONE PLoS ONE, 13(4), e0195260 PLoS ONE, Vol 13, Iss 4, p e0195260 (2018) PLoS One, 13, 4 PLoS One, 13 PLOS ONE, 13(4):0195260. Public Library of Science |
| ISSN: | 1932-6203 |
| Popis: | The treatment of persistent symptoms attributed to Lyme disease remains controversial. Recently, the PLEASE study did not demonstrate any additional clinical benefit of longer-term versus shorter-term antibiotic treatment. However, the economic impact of the antibiotic strategies has not been investigated. MethodsThis prospective economic evaluation, adhering a societal perspective, was performed alongside the PLEASE study, a multicenter, placebo-controlled, double-blind 1:1:1 randomized clinical trial in which all patients received open-label intravenous ceftriaxone for two weeks before the 12-week randomized blinded oral antibiotic regimen (doxycycline, clarithromycin plus hydroxychloroquine, or placebo). Between 2010 and 2013, patients (n = 271) with borreliosis-attributed persistent symptoms were enrolled and followed for one year. Main outcomes were costs, quality-adjusted life years, and incremental net monetary benefit of longer-term versus shorter-term antibiotic therapy. ResultsMean quality-adjusted life years (95% CI) were not significantly different (p = 0.96): 0.82 (0.77–0.88) for ceftriaxone/doxycycline (n = 82), 0.81 (0.76–0.88) for ceftriaxone/clarithromycin-hydroxychloroquine (n = 93), and 0.81 (0.76–0.86) for ceftriaxone/placebo (n = 96). Total societal costs per patient (95% CI) were not significantly different either (p = 0.35): €11,995 (€8,823-€15,670) for ceftriaxone/doxycycline, €12,202 (€9,572-€15,253) for ceftriaxone/clarithromycin-hydroxychloroquine, and €15,249 (€11,294-€19,781) for ceftriaxone/placebo. Incremental net monetary benefit (95% CI) for ceftriaxone/doxycycline compared to ceftriaxone/placebo varied from €3,317 (-€2,199-€8,998) to €4,285 (-€6,085-€14,524) over the willingness-to-pay range, and that of ceftriaxone/clarithromycin-hydroxychloroquine compared to ceftriaxone/placebo from €3,098 (-€888-€7,172) to €3,710 (-€4,254-€11,651). For every willingness-to-pay threshold, the incremental net monetary benefits did not significantly differ from zero. ConclusionThe longer-term treatments were similar with regard to costs, effectiveness and cost-effectiveness compared to shorter-term treatment in patients with borreliosis-attributed persistent symptoms after one year of follow-up. Given the results of this study, and taking into account the external costs associated with antibiotic resistance, the shorter-term treatment is the antibiotic regimen of first choice. |
| Databáze: | OpenAIRE |
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