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

Holmes, Emily AF, Harris, Sharman D, Hughes, Alison, Craine, Noel and Hughes, Dyfrig A ORCID: 0000-0001-8247-7459 (2018) Cost-Effectiveness Analysis of the Use of Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing in Primary Care. ANTIBIOTICS-BASEL, 7 (4). E106-.

Access the full-text of this item by clicking on the Open Access link.

Official URL: http://dx.doi.org/10.3390/antibiotics7040106

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 <i>Clostridium difficile</i> infection warrant further investigation.

Item Type:	Article
Uncontrolled Keywords:	economic evaluation, cost-utility analysis, cost-effectiveness analysis, antibiotics, primary care, respiratory tract infection, point-of-care testing, C-reactive protein, antimicrobial resistance, Clostridium difficile
Depositing User:	Symplectic Admin
Date Deposited:	24 Jan 2019 16:29
Last Modified:	07 Feb 2024 17:57
DOI:	10.3390/antibiotics7040106
Open Access URL:	https://www.mdpi.com/2079-6382/7/4/106
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3031758