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


Oppong, R; Jit, M; Smith, RD; Butler, CC; Melbye, H; Mölstad, S; Coast, J; (2013) Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions. The British journal of general practice , 63 (612). e465-71. ISSN 0960-1643 DOI: 10.3399/bjgp13X669185

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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 €9391. At a willingness-to-pay threshold of €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.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Public Health and Policy
Research Centre: Antimicrobial Resistance Centre (AMR)
Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 23834883
Web of Science ID: 325526100005
URI: http://researchonline.lshtm.ac.uk/id/eprint/1236251

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