Cost-effectiveness and return-on-investment of C-reactive protein point-of-care testing in comparison with usual care to reduce antibiotic prescribing for lower respiratory tract infections in nursing homes: a cluster randomised trial

Boere, Tjarda M.; Alili, Mohamed El; Buul, Laura W van; Hopstaken, Rogier; Verheij, Theo; Hertogh, Cees M.P.M.; Tulder, Maurits W. van; Bosmans, Judith E.

doi:10.1136/bmjopen-2021-055234

Cited by 4 publications

(2 citation statements)

References 57 publications

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“… 36 Higher ICERs were seen in specific populations such as nursing homes or patients with COPD. 34 , 35 Studies that did not include cost savings from reduced antibiotic prescribing also made higher estimates. 31 It is also noteworthy that clinical and cost efficacy were generally higher in modelling studies, based on hypothesized parameters, relative to evaluations based on RCT data.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of point-of-care diagnostics for AMR: a systematic review

Tolley,

Bansal,

Murerwa

et al. 2024

Journal of Antimicrobial Chemotherapy

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Background Antimicrobial resistance (AMR) is a major threat to global health. By 2050, it is forecast that AMR will cause 10 million deaths and cost 100 trillion USD annually. Point-of-care tests (POCTs) may represent a cost-effective approach to reduce AMR. Objectives We systematically reviewed which POCTs addressing AMR have undergone economic evaluation in primary and secondary healthcare globally, how these POCTs have been economically evaluated, and which are cost-effective in reducing antimicrobial prescribing or the burden of AMR. Clinical cost-effectiveness was additionally addressed. Methods This systematic review, accordant with PRISMA guidelines, was pre-registered on PROSPERO (CRD42022315192). MEDLINE, PubMed, Embase, Cochrane Library, and Google Scholar were searched from 2000 to 2023 for relevant publications. Quality assessment was performed using the Consensus of Health Economic Criteria. Results The search strategy identified 1421 studies, of which 20 met the inclusion criteria. The most common POCTs assessed were for respiratory infections (n = 10), STIs (n = 3), and febrile patients in low- and middle-income countries (n = 3). All studies assessed costs from a healthcare provider perspective; five additionally considered the societal cost of AMR. Eighteen studies identified POCT strategies that reduced antimicrobial prescribing. Of these, 10 identified POCTs that would be considered cost-effective at a willingness-to-pay (WTP) threshold of £33.80 per antibiotic prescription avoided. Most POCT strategies improved clinical outcomes (n = 14); the remainder were clinically neutral. Conclusions There is evidence that some POCTs are cost-effective in reducing antimicrobial prescribing, with potential concomitant clinical benefits. Such interventions—especially CRP POCTs in both high- and low-income settings—merit further, large-scale clinical evaluation.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of point-of-care diagnostics for AMR: a systematic review

Tolley,

Bansal,

Murerwa

et al. 2024

Journal of Antimicrobial Chemotherapy

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“…The use of CRP in primary practice was associated with similar results, and overall benefits balance potential harms [ 37 , 38 , 39 ]. However, the use of CTP-POCT did not influence the clinical recovery, resolution of symptoms and hospital admissions when compared to the usual care [ 42 , 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Positive Point-of-Care Influenza Test Significantly Decreases the Probability of Antibiotic Treatment during Respiratory Tract Infections in Primary Care

Rzepka¹,

Mania

2023

Diagnostics

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This study aimed to analyse clinical and laboratory findings in primary care patients with respiratory tract infections to distinguish the group more likely to receive antibiotic treatment. The study group consisted of 631 patients (264 males; 367 females) with a median age of 48 years (IQR 36–63 years). Analysed groups included patients treated with antibiotics (n = 269 patients; 43%) and those who recovered without antibiotic treatment (n = 362 patients; 57%). Patients receiving antibiotics were older (median 51 vs. 47 years; p = 0.008) and more commonly developed fever (77% vs. 25%, p < 0.0001) and cough (63% vs. 30%; p = 0.0014). Moreover, they more frequently presented wheezing and crackles upon physical examination (28% vs. 4% and 9% vs. 0.3%; p < 0.0001 and p < 0.0001, respectively). They also had more comorbidities and came to more follow-up visits (median of 4 vs. 3 and 2 vs. 1, p < 0.0001 and p < 0.0001, respectively). Patients receiving symptomatic therapy more often had positive point-of-care tests (POCTS)—20% vs. 7%; p = <0.0001. Multivariate analysis in our cohort found comorbidities complexity (odds ratio—OR 2.62; 95% confidence interval—1.54–4.46), fever (OR 32.59; 95%CI 19.15–55.47), crackles (OR 26.35; 95%CI 2.77–250.81) and the number of visits (OR 4.15; 95%CI 2.39–7.20) as factors increasing the probability of antibiotic treatment. Positive influenza POCTS reduced the risk of antibiotic therapy (OR 0.0015; 95%CI 0.0001–0.0168).

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Combined Charlson comorbidity/C-Reactive Protein Index Is a Novel Predictor in Renal Cell Carcinoma: Analysis of the International Marker Consortium for Renal Cancer (INMARC) Registry

Cortes,

Saitta,

Yuen

et al. 2024

Clinical Genitourinary Cancer

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Cost-effectiveness and return-on-investment of C-reactive protein point-of-care testing in comparison with usual care to reduce antibiotic prescribing for lower respiratory tract infections in nursing homes: a cluster randomised trial

Abstract: Costeffectiveness and returnon-investment of C-reactive protein point-of-care testing in comparison with usual care to reduce antibiotic prescribing for lower respiratory tract infections in nursing homes: a cluster randomised trial. BMJ Open 2022;12:e055234.

Cited by 4 publications

References 57 publications

Cost-effectiveness of point-of-care diagnostics for AMR: a systematic review

Cost-effectiveness of point-of-care diagnostics for AMR: a systematic review

Positive Point-of-Care Influenza Test Significantly Decreases the Probability of Antibiotic Treatment during Respiratory Tract Infections in Primary Care

Combined Charlson comorbidity/C-Reactive Protein Index Is a Novel Predictor in Renal Cell Carcinoma: Analysis of the International Marker Consortium for Renal Cancer (INMARC) Registry

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