Previous Article in Journal
Bystander Phage Therapy: Inducing Host-Associated Bacteria to Produce Antimicrobial Toxins against the Pathogen Using Phages
Previous Article in Special Issue
The Consequences of AMR Education and Awareness Raising: Outputs, Outcomes, and Behavioural Impacts of an Antibiotic-Related Educational Activity in Lao PDR
Article Menu

Export Article

Open AccessArticle
Antibiotics 2018, 7(4), 106; https://doi.org/10.3390/antibiotics7040106 (registering DOI)

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

1
Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Normal Site, Bangor, Gwynedd LL57 2PZ, UK
2
Department of Blood Sciences, Betsi Cadwaladr University Health Board, Ysbyty Gwynedd LL57 2PW, UK
3
Head of Pharmacy Primary Care and Community West, Betsi Cadwaladr University Health Board, Pharmacy Office, Eryldon, Campbell Rd, Caernarfon, Gwynedd LL55 1HU, UK, [email protected]
4
Public Health Wales, Microbiology Department, Ysbyty Gwynedd, Bangor, Gwynedd LL57 2PW, UK
*
Author to whom correspondence should be addressed.
Received: 19 October 2018 / Revised: 20 November 2018 / Accepted: 3 December 2018 / Published: 7 December 2018
Full-Text   |   PDF [2863 KB, uploaded 7 December 2018]   |  
  |   Review Reports

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. View Full-Text
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 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
Figures

Figure 1

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

Share & Cite This Article

MDPI and ACS Style

Holmes, E.A.F.; Harris, S.D.; Hughes, A.; Craine, N.; Hughes, D.A. Cost-Effectiveness Analysis of the Use of Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing in Primary Care. Antibiotics 2018, 7, 106.

Show more citation formats Show less citations formats

Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Related Articles

Article Metrics

Article Access Statistics

1

Comments

[Return to top]
Antibiotics EISSN 2079-6382 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top