Inappropriate Antibiotic Prescribing at Dental Visits Incurs Annual Costs of $31 Million

USA: Improper antibiotic prescribing during dental visits costs an estimated $31 million annually, with the majority of expenses being out-of-pocket burdens on patients, according to recent research. 

This significant economic impact has prompted concerns among healthcare professionals about the unnecessary costs and potential adverse effects associated with the practice.

Response to Preventive Measures for Infective Endocarditis

Cynthia L. Gong, PharmD, PhD, an assistant professor in the Department of Pediatrics at the University of Southern California’s Keck School of Medicine, highlighted the study’s origin in response to the ongoing issue of inappropriate antibiotic prescribing in dentistry, particularly concerning infective endocarditis prevention. 

Despite guidelines advising antibiotic prophylaxis only for high-risk individuals, a substantial number of prescriptions do not align with these recommendations. The study’s main goal was to quantify the financial toll of this practice and evaluate its impact from the perspective of healthcare payers.

Assessing the Costs and Impact

The researchers used 2018 census data to model adults aged 18 years and older in the United States who had a dental visit with an antibiotic prescription over a one-year period. They assessed the costs associated with drug-related adverse effects, focusing on the most impactful events linked to dental antibiotic prophylaxis: Clostridioides difficile infection (CDI) and anaphylaxis or severe hypersensitivity requiring an emergency department visit or hospitalization. 

Furthermore, the study examined the potential risk of infective endocarditis if inappropriate antibiotic prescribing was not practiced, utilizing the reported incidence of infective endocarditis among patients without known predisposing cardiac conditions undergoing dental procedures.

Alarming Financial and Health Consequences

Based on their model, the researchers estimated that out of 253,815,197 U.S. adults, 167,010,400 (65.8%) underwent a dental visit each year, with 7,965,084 (4.8%) receiving prophylactic antibiotics, of which 6,617,132 (83.1%) were inappropriately prescribed. 

The financial burden of this practice was significant, amounting to approximately $10.8 million in excess healthcare costs each year. This included antibiotic expenditures of $2.69 million annually and adverse effects costs of $5.82 million, $1.99 million, and $380,849 for amoxicillin, clindamycin, and cephalexin, respectively. Out-of-pocket expenses borne by patients accounted for $20,500,703, contributing to the total annual cost of $31 million.

In addition to financial repercussions, inappropriate prophylaxis led to an excess of 768 inpatient CDI cases and up to 103 cases of severe hypersensitivity or anaphylaxis requiring hospitalization, amounting to $7.30 million and $874,584, respectively. 

In the absence of inappropriate antibiotic use, the researchers projected a potential reduction of approximately three cases of infective endocarditis, resulting in annual savings of $131,149.

Urgent Need for Addressing the Issue

Gong emphasized the crucial role dentists play in antibiotic prescriptions, accounting for 6% to 10% of all antibiotic prescriptions in the U.S. To mitigate preventable adverse effects, healthcare costs, and the emergence of antibiotic resistance, addressing the issue of inappropriate antibiotic use in dentistry is of paramount importance.

The study’s findings underscore the necessity for enhanced awareness and adherence to guidelines, promoting responsible antibiotic prescribing practices to ensure the well-being of patients and the efficient allocation of healthcare resources.