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Randomized Controlled Trial
. 2014 Feb 14;9(2):e82694.
doi: 10.1371/journal.pone.0082694. eCollection 2014.

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

James M Mason  1 , Kim S Thomas  2 , Angela M Crook  3 , Katharine A Foster  2 , Joanne R Chalmers  2 , Andrew J Nunn  3 , Hywel C Williams  2
Affiliations
Randomized Controlled Trial

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

James M Mason et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Analysis of recurrence rates in the PATCH trials, exploring on-prophylaxis, post-prophylaxis and overall rates.
Figure 2
Figure 2. Cost-effectiveness plane (NHS costs and benefits discounted at 3.5%).
Figure 3
Figure 3. Cost-effectiveness acceptability curves (CEACs), NHS and Societal costs and benefits discounted at 3.5%.
Figure 4
Figure 4. Sensitivity Analyses exploring influence of cost outliers and individual trials, NHS and Societal costs and benefits discounted at 3.5%.
See this image and copyright information in PMC

References

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