Antibiotic prescription for acute sinusitis in otherwise healthy adults - Clinical cure in relation to costs

Objective - To determine which treatment strategy offers the most cost-effective option in managing acute sinusitis.Design - The modelling procedure included five clinical strategies, varying from "wait and see for a week", to "prescribing antibiotics selectively" to "prescribing antibiotics immediately" and to "performing further diagnostics".Setting - Outpatient clinics and primary health care.Patients - Data were derived from clinical trials that included otherwise healthy patients with acute sinusitis.Main outcome measures - The marginal cost-effectiveness.Results - By using the strategy "wait and see for a week", 91.5% of the patients, by "prescribing antibiotics selectively", 93.2% of the patients, and by "prescribing antibiotics immediately", 94.5% of the patients were cured after a 1-week period. The costs for curing one additional patient were Dutch Florin (DFL) 516 when antibiotics were selectively prescribed, and DPL 882 when antibiotics were immediately prescribed. Further diagnostic procedures did not improve outcome in terms of marginal cost-effectiveness.Conclusions - In patients presenting with acute sinusitis, postponing antibiotics for 1,week is the most cost-effective strategy.