Cost-effectiveness analysis for SilAtro-5-90 adjuvant treatment in the management of recurrent tonsillitis, compared with usual care only

Abstract

Purpose Antibiotics are one possible treatment for patients with recurrent acute throat infections (ATI), but effectiveness can be modest. In view of worries over antibiotic resistance, treatment pathways that reduce recurrence of ATI are essential from a public health perspective. Integrative treatment strategies can be an option but there is still a high demand to provide evidence of their cost effectiveness. Methods We constructed a 4-state Markov model to compare the cost-effectiveness of SilAtro-5-90 as adjuvant homeopathic therapy to care as usual with care as usual alone in reducing the recurrence of ATI for children and adults with suspected moderate recurrent tonsillitis. The analysis was performed from a societal perspective in Germany over a 2-year period. Results are reported separately for children < 12 and for individuals aged 12 and over. The model draws on evidence from a multi-centre randomised clinical trial that found this strategy effective in reducing recurrence of ATI. Costs in 2019 € and outcomes after 1 year are discounted at a rate of 3% per annum. Results For adults and adolescents aged 12 years and over, incremental cost per ATI averted in the adjuvant therapy group was €156.64. If individuals enter the model on average with a history of 3.33 previous ATIs, adjuvant therapy has both lower costs and better outcomes than care as usual. For children (< 12 years) adjuvant therapy had both lower costs and ATI than care as usual. The economic case is stronger if adjuvant treatment reduces surgical referral. At a hypothetical cost per ATI averted threshold of €1000 probabilistic sensitivity analysis suggests Silatro-5-90 has a 65% (adults) and 71% (children) chance of being cost-effective. Conclusion Our results indicate the importance of considering homeopathy as adjuvant therapy in the treatment of ATIs in individuals with recurrent tonsillitis from a socio-economic perspective. Further evaluation should assess how differences in uptake and sustained use of homeopathic adjuvant therapy, as well as changing patterns of antibiotic prescribing, impact on cost effectiveness.

Modalities of group A streptococcal prevention and treatment and their economic justification

“…Two of those studies evaluated tonsillectomy as a prevention strategy for frequently recurring pharyngitis 58 , 59 , and they both found that tonsillectomy was cost-effective compared to usual care. One study found that homeopathic remedy (SilAtro-5–90) as an adjuvant to normal treatment was cost-effective in preventing recurrent pharyngitis 60 . Lastly, a study evaluating strategies to prevent recurrent cellulitis found that antibiotic prophylaxis was not associated with a significant increase in costs but reduced the risk of recurrence by nearly a third 61 .…”

Agraphis nutans in Treatment of Chronic Tonsillitis: Randomised, Pragmatic, Equivalence Trial

“…25 In a subsequent study, adjuvant SilAtro-5–90 was found to be cost-effective in the management of recurrent tonsillitis, compared with usual care only. 26…”

“…25 In a subsequent study, adjuvant SilAtro-5-90 was found to be cost-effective in the management of recurrent tonsillitis, compared with usual care only. 26 Another important finding of the trial was deterioration of halitosis (F 2, 28 ¼ 4.311, p ¼ 0.023) and nocturnal breathing (F 2, 28 ¼ 1.249, p ¼ 0.302) subscales of the TAHSI instrument in the AN group, whereas the IHMs revealed significant improvement in these two subscales (halitosis: F 2, 28 ¼ 11.860, p < 0.001; nocturnal breathing: F 2, 28 ¼ 6.190, p ¼ 0.006). However, TAHSI being the secondary outcome measure, drawing inference was not based on these findings.…”