Cost-Effectiveness Analysis of the Use of Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing in Primary Care

Abstract

More appropriate and measured use of antibiotics may be achieved using point-of-care (POC) C-reactive protein (CRP) testing, but there is limited evidence of cost-effectiveness in routine practice. A decision analytic model was developed to estimate the cost-effectiveness of testing, compared with standard care, in adults presenting in primary care with symptoms of acute respiratory tract infection (ARTI). Analyses considered (1) pragmatic use of testing, reflective of routine clinical practice, and (2) testing according to clinical guidelines. Threshold and scenario analysis were performed to identify cost-effective scenarios. In patients with symptoms of ARTI and based on routine practice, the incremental cost-effectiveness ratios of CRP testing were £19,705 per quality-adjusted-life-year (QALY) gained and £16.07 per antibiotic prescription avoided. Following clinical guideline, CRP testing in patients with lower respiratory tract infections (LRTIs) cost £4390 per QALY gained and £9.31 per antibiotic prescription avoided. At a threshold of £20,000 per QALY, the probabilities of POC CRP testing being cost-effective were 0.49 (ARTI) and 0.84 (LRTI). POC CRP testing as implemented in routine practice is appreciably less cost-effective than when adhering to clinical guidelines. The implications for antibiotic resistance and Clostridium difficile infection warrant further investigation.

Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing for Respiratory Tract Infections in Primary Care: Systematic Review and Meta-Analysis of Randomised Controlled Trials

“…After full-text evaluation, 152 publications were relevant for POCT. After excluding 34 publications [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ] ( Supplementary Materials ), 13 studies [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ] reported across 22 publications [ 61 , 62 , 63 …”

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…Restricting or addressing inappropriate pharmaceutical company activities is particularly important in LMICs, where companies can be the principal source of physician education regarding antibiotics 330,331 . Selective point-of-care testing is seen as potentially beneficial in patients with URTIs 101,332 , and decision support systems have been shown to reduce the overuse of antibiotics in ambulatory care settings 333 . Social norm feedback among physicians can also appreciably reduce antibiotic prescribing in ambulatory care 334 .…”

Application of a simple point-of-care test to reduce UK healthcare costs and adverse events in outpatient acute respiratory infections

“…Since published data indicate that patients older than 16 years of age represent the majority of patients receiving antibiotics, the most frequently prescribed antibiotics for patients 16 years and older was used to generate an average antibiotic cost of £1.21 per ARI episode 40 . A dispensing fee of £1.90 was added to the average antibiotic cost and was assumed to be included for every prescription, based on the mean dispensing rate per item for pharmacists 41 . Out-ofpocket payments for prescription charges applicable to these medicines were not included.…”