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Titolo:
Strategies for diagnosing and treating suspected acute bacterial sinusitis- A cost-effectiveness analysis
Autore:
Balk, EM; Zucker, DR; Engels, EA; Wong, JB; Williams, JW; Lau, J;
Indirizzi:
Tufts Univ, Sch Med, New England Med Ctr, Div Clin Care Res,Evidenced Based Practice Ctr, Boston, MA 02111 USA Tufts Univ Boston MA USA 02111 d Based Practice Ctr, Boston, MA 02111 USA Tufts Univ, Sch Med, New England Med Ctr, Div Clin Decis Making Informat &Telemed, Boston, MA 02111 USA Tufts Univ Boston MA USA 02111 ng Informat &Telemed, Boston, MA 02111 USA NCI, Div Canc Epidemiol & Genet, Viral Epidemiol Branch, Rockville, MD USANCI Rockville MD USA & Genet, Viral Epidemiol Branch, Rockville, MD USA Durham VAMC, Vet Affairs HSR&D Ctr Excellence, Durham, NC USA Durham VAMCDurham NC USA t Affairs HSR&D Ctr Excellence, Durham, NC USA Duke Univ, Med Ctr, Div Gen Internal Med, Durham, NC USA Duke Univ DurhamNC USA v, Med Ctr, Div Gen Internal Med, Durham, NC USA
Titolo Testata:
JOURNAL OF GENERAL INTERNAL MEDICINE
fascicolo: 10, volume: 16, anno: 2001,
pagine: 701 - 711
SICI:
0884-8734(200110)16:10<701:SFDATS>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
RECOMMENDATIONS; METAANALYSIS; AMOXICILLIN; ANTIBIOTICS; MEDICINE; ADULTS; HEALTH;
Keywords:
acute bacterial sinusitis; decision analysis; cost-effectiveness analysis; Markov model;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Lau, J Tufts Univ, Sch Med, New England Med Ctr, Div Clin Care Res,Evidenced Based Practice Ctr, 63,750 Washington St, Boston, MA 02111 USA Tufts Univ 63,750 Washington St Boston MA USA 02111 n, MA 02111 USA
Citazione:
E.M. Balk et al., "Strategies for diagnosing and treating suspected acute bacterial sinusitis- A cost-effectiveness analysis", J GEN INT M, 16(10), 2001, pp. 701-711

Abstract

OBJECTIVE: Symptoms suggestive of acute bacterial sinusitis are common. Available diagnostic and treatment options generate substantial costs with uncertain benefits. We assessed the cost-effectiveness of alternative management strategies to identify the optimal approach. DESIGN. For such patients, we created a Markov model to examine four strategies: 1) no antibiotic treatment; 2) empirical antibiotic treatment; 3) clinical criteria-guided treatment; and 4) radiography-guided treatment. The model simulated a 14-day course of illness, included sinusitis prevalence, antibiotic side effects, sinusitis complications, direct and indirect costs, and symptom severity. Strategies costing less than $50,000 per quality-adjusted life year gained were considered "cost-effective. "MEASUREMENTS AND MAIN RESULTS: For mild or moderate disease, basing antibiotic treatment on clinical criteria was cost-effective in clinical settingswhere sinusitis prevalence is within the range of 15% to 93% or 3% to 63%,respectively. For severe disease, or to prevent sinusitis or antibiotic side effect symptoms, use of clinical criteria was cost-effective in settingswith lower prevalence (below 51% or 44%, respectively); empirical antibiotics was cost-effective with higher prevalence. Sinus radiography-guided treatment was never cost-effective for initial treatment. CONCLUSIONS: Use of a simple set of clinical criteria to guide treatment Is a cost-effective strategy in most clinical settings. Empirical antibiotics are cost-effective in certain settings; however, their use results in many unnecessary prescriptions. If this resulted in increased antibiotic resistance, costs would substantially rise and efficacy would fall. Newer, expensive antibiotics are of limited value. Additional testing is not cost-effective. Further studies are needed to find an accurate, low-cost diagnostic test for acute bacterial sinusitis.

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Documento generato il 26/01/21 alle ore 03:41:48