Advanced

Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions

Oppong, Raymond; Jit, Mark; Smith, Richard D.; Butler, Christopher C.; Melbye, Hasse; Mölstad, Sigvard LU and Coast, Joanna (2013) In British Journal of General Practice 63(612). p.465-471
Abstract
Background Point-of-care C-reactive protein (POCCRP) is a biomarker of inflammation that offers clinicians a rapid POC test to guide antibiotic prescribing decisions for acute cough and lower respiratory tract infections (LRTI). However, evidence that POCCRP is cost-effective is limited, particularly outside experimental settings. Aim To assess the cost-effectiveness of POCCRP as a diagnostic tool for acute cough and LRTI from the perspective of the health service. Design and setting Observational study of the presentation, management, and outcomes of patients with acute cough and LRTI in primary care settings in Norway and Sweden. Method Using hierarchical regression, data were analysed in terms of the effect on antibiotic use, cost, and... (More)
Background Point-of-care C-reactive protein (POCCRP) is a biomarker of inflammation that offers clinicians a rapid POC test to guide antibiotic prescribing decisions for acute cough and lower respiratory tract infections (LRTI). However, evidence that POCCRP is cost-effective is limited, particularly outside experimental settings. Aim To assess the cost-effectiveness of POCCRP as a diagnostic tool for acute cough and LRTI from the perspective of the health service. Design and setting Observational study of the presentation, management, and outcomes of patients with acute cough and LRTI in primary care settings in Norway and Sweden. Method Using hierarchical regression, data were analysed in terms of the effect on antibiotic use, cost, and patient outcomes (symptom severity after 7 and 14 days, time to recovery, and EQ-5D), while controlling for patient characteristics (self-reported symptom severity, comorbidities, and health-related quality of life) at first attendance. Results POCCRP testing is associated with non-significant positive reductions in antibiotic prescribing (P = 0.078) and increased cost (P = 0.092). Despite the uncertainty, POCCRP testing is also associated with a cost per quality-adjusted life year (QALY) gain of (sic)9391. At a willingness-to-pay threshold of (sic)30 000 per QALY gained, there is a 70% probability of CRP being cost-effective. Conclusion POCCRP testing is likely to provide a cost-effective diagnostic intervention both in terms of reducing antibiotic prescribing and in terms of QALYs gained. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
antibiotics, cost-effectiveness, C-reactive protein, primary health, care, respiratory tract infections
in
British Journal of General Practice
volume
63
issue
612
pages
465 - 471
publisher
Royal College of General Practitioners
external identifiers
  • wos:000325526100005
  • scopus:84880530477
ISSN
1478-5242
DOI
10.3399/bjgp13X669185
language
English
LU publication?
yes
id
1e41121d-fc05-4d24-8b3c-a47f03eea369 (old id 4170538)
date added to LUP
2013-12-06 12:29:09
date last changed
2019-02-20 01:53:37
@article{1e41121d-fc05-4d24-8b3c-a47f03eea369,
  abstract     = {Background Point-of-care C-reactive protein (POCCRP) is a biomarker of inflammation that offers clinicians a rapid POC test to guide antibiotic prescribing decisions for acute cough and lower respiratory tract infections (LRTI). However, evidence that POCCRP is cost-effective is limited, particularly outside experimental settings. Aim To assess the cost-effectiveness of POCCRP as a diagnostic tool for acute cough and LRTI from the perspective of the health service. Design and setting Observational study of the presentation, management, and outcomes of patients with acute cough and LRTI in primary care settings in Norway and Sweden. Method Using hierarchical regression, data were analysed in terms of the effect on antibiotic use, cost, and patient outcomes (symptom severity after 7 and 14 days, time to recovery, and EQ-5D), while controlling for patient characteristics (self-reported symptom severity, comorbidities, and health-related quality of life) at first attendance. Results POCCRP testing is associated with non-significant positive reductions in antibiotic prescribing (P = 0.078) and increased cost (P = 0.092). Despite the uncertainty, POCCRP testing is also associated with a cost per quality-adjusted life year (QALY) gain of (sic)9391. At a willingness-to-pay threshold of (sic)30 000 per QALY gained, there is a 70% probability of CRP being cost-effective. Conclusion POCCRP testing is likely to provide a cost-effective diagnostic intervention both in terms of reducing antibiotic prescribing and in terms of QALYs gained.},
  author       = {Oppong, Raymond and Jit, Mark and Smith, Richard D. and Butler, Christopher C. and Melbye, Hasse and Mölstad, Sigvard and Coast, Joanna},
  issn         = {1478-5242},
  keyword      = {antibiotics,cost-effectiveness,C-reactive protein,primary health,care,respiratory tract infections},
  language     = {eng},
  number       = {612},
  pages        = {465--471},
  publisher    = {Royal College of General Practitioners},
  series       = {British Journal of General Practice},
  title        = {Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions},
  url          = {http://dx.doi.org/10.3399/bjgp13X669185},
  volume       = {63},
  year         = {2013},
}