Prevention of Lyme Disease after Tick Bites: A Cost-Effectiveness Analysis

In areas of endemic disease, the probability of Lyme disease after a tick bite ranges from about 0.012 to 0.05. Early treatment with oral antibiotics prevents most complications of Lyme disease, but antibiotics are generally not prescribed until rash or other symptoms develop. We used decision analysis to evaluate the outcomes, costs, and cost effectiveness of three alternative strategies to treat patients bitten by ixodes ticks in areas of endemic Lyme disease: empirically treat all patients with two weeks of doxycycline, treat only patients in whom erythema migrans develops, and treat only patients with erythema migrans or a positive serologic test for Lyme disease one month after exposure. Empirical treatment is the least expensive strategy and results in the fewest cases of Lyme disease and the fewest complications when the probability of Borrelia burgdorferi infection after a tick bite is 0.036 or higher. For probabilities of infection below 0.036, empirical therapy prevents most major complications, sequelae, and adverse events, but it incurs additional minor complications, especially as the probability of infection falls below 0.01. Empirical treatment of patients with tick bites is indicated when the probability of B. burgdorferi infection after a bite is 0.036 or higher, and this treatment may be preferred when the probability of infection ranges from 0.01 to 0.035. When the probability of infection after a tick bite is less than 0.01, empirical therapy is not warranted. (N Engl J Med 1992;327:534–41.), LYME disease is a multisystem disorder caused by the spirochete Borrelia burgdorferi. Spread to humans by infected ticks, it is the most common vector-borne illness in the United States.¹ The primary vectors are Ixodes dammini in the northeast and midwestern United States^{2 , 3} and I. pacificus on the West Coast.⁴ The probability of contracting Lyme disease after a tick bite in an area of endemic disease has been reported to range from 0.012 to 0.05 (pooled estimate from four studies, 0.027; 95 percent confidence interval, 0.013 to 0.049).^{5 6 7 8} Early Lyme disease (localized infection) is often marked by the development of…