Inappropriate antibiotic prescribing at dental visits costs millions annually
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Key takeaways:
- More than 6.6 million antibiotics are inappropriately prescribed at dental visits each year.
- These prescriptions cost $31 million each year in health care costs and out-of-pocket expenses.
Inappropriate antibiotic prescribing at dental visits costs approximately $31 million annually, most of which are out-of-pocket expenses for patients, researchers determined.
“The study was prompted by the ongoing issue of inappropriate antibiotic prescribing in dentistry for the prevention of infective endocarditis,” Cynthia L. Gong, PharmD, PhD, assistant professor in the department of pediatrics at the University of Southern California’s Keck School of Medicine, told Healio.
“Despite guidelines limiting antibiotic prophylaxis to high-risk individuals, a significant number of prescriptions are inconsistent with these recommendations. The study aimed to estimate the costs associated with this practice and assess its impact from a health care payer perspective,” Gong said.
Using 2018 census data, Gong and colleagues modeled adults aged 18 years and older in the United States who had a dental visit with an antibiotic prescribed over a 1-year period. They then calculated the costs of drug-related adverse effects by estimating the likelihood of the most impactful adverse events related to dental antibiotic prophylaxis — Clostridioides difficile infection (CDI) and anaphylaxis or severe hypersensitivity requiring an ED visit or hospitalization.
According to the study, they also evaluated the potential risk of infective endocarditis if inappropriate antibiotic prescribing did not occur by using the reported incidence of infective endocarditis among patients without known predisposing cardiac conditions undergoing dental procedures.
The model estimated that among 253,815,197 U.S. adults, 167,010,400 (65.8%) have a dental visit each year, among whom 7,965,084 (4.8%) receive prophylactic antibiotics of which 6,617,132 (83.1%) are inappropriately prescribed.
Based on this, the researchers estimate approximately $10.8 million in excess health care costs are incurred each year, which includes antibiotic use amounting to $2.69 million per year, and adverse effects costs of $5.82 million, $1.99 million and $380,849 for amoxicillin, clindamycin and cephalexin, respectively. These antibiotic prescriptions also cost $20,500,703 in out-of-pocket expenses annually, which together with the excess health care costs totals approximately $31 million each year.
Additionally, the study showed that inappropriate prophylaxis led to an excess 768 inpatient CDI cases annually and up to 103 cases of severe hypersensitivity or anaphylaxis requiring hospitalization, which the researchers say amounted to $7.30 million and $874,584, respectively. Had inappropriate antibiotic use not occurred, the researchers estimated approximately three cases of infective endocarditis resulting in $131,149 per year.
“Dentists play a substantial role in antibiotic prescriptions, accounting for 6% to 10% of all antibiotic prescriptions in the U.S.,” Gong said. “Addressing the issue of inappropriate antibiotic use in dentistry is crucial to reduce the burden of preventable adverse effects and health care costs and downstream antibiotic resistance.”
Gong CL, et al. Infect Control Hosp Epidemiol. 2023;doi:10.1017/ice.2023.126.
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