Cost-EffectivenessCost-effectiveness studies have suggested benefit from antibiotic prophylaxis, but the assumptions inherent to these studies were inappropriate, limiting the usefulness of their conclusions. Two recent analyses were performed – one in the general population and one in patients with mitral valve prolapse. The study in the general population assumed that antibiotic prophylaxis is 100% effective, which is unlikely, and that 15% of IE (Infective Endocarditis) cases are related to dental procedures, although this number has been estimated to be closer to 4% to 10% in other studies. The mitral valve prolapse analysis also assumed 80% efficacy. Further study in this area is needed, with application of more accurate estimates of patient and physician adherence to recommendations, effectiveness of prophylaxis, and updated costs of complications of endocarditis and costs of antibiotic use.
Considering ReferralThe current recommendations for antibiotic prophylaxis of IE are designed to facilitate widespread application by primary care physicians. Some possible reasons for referral would include the work-up of an undiagnosed murmur, clarification of a congenital heart defect, or suspected penicillin allergy.*51/348/5*
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