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Cost-effectiveness of primary care treatment of sinusitis depends on individual, societal, and payer's perspectives

Most acute sinusitis cases diagnosed in primary care offices are due to viral upper respiratory tract infections and not bacterial infections that are treatable with antibiotics (Abx). However, there is no simple, quick, and inexpensive test to differentiate bacterial from viral sinusitis. This often leads to overprescribing of antibiotics for sinusitis and resulting antibiotic-resistant infections, which have become a major public health problem, note Yoshimi Anzai, M.D., M.P.H., and University of Washington colleagues. They used a simulation model to compare four treatment strategies: no Abx, empiric Abx (based on sinus culture), computerized tomography (CT)-based Abx, and clinical guideline-based Abx (based on clinical signs and symptoms).

From an individual and short-term societal perspective, empiric Abx was the most cost-effective, because Abx typically shortens the length of illness and lost work days. However, Abx resistance will lead to increased costs and reduced efficacy of currently used antibiotics in the long-term. The effectiveness of CT-guided Abx treatment was offset by the large additional cost of imaging. From the payer's perspective, clinical guideline-based treatment was the most cost-effective at $38,515 per quality-adjusted life year.

The researchers conclude that clinical guidelines provide a low-cost method of targeting therapy. The study was supported in part by the Agency for Healthcare Research and Quality (HS13613).

See "The cost-effectiveness of the management of acute sinusitis," by Dr. Anzai, Jeffrey G. Jarvik, M.D., M.P.H., Sean D. Sullivan, Ph.D., and William Hollingworth, Ph.D., in the July-August 2007 American Journal of Rhinology 21(4), pp. 444-451.

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