Cost-Effectiveness of Point-of-Care C-Reactive Protein Tests for Respiratory Tract Infection in Primary Care in England
Cost-Effectiveness of Point-of-Care C-Reactive Protein Tests for Respiratory Tract Infection in Primary Care in England
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DOI：
10.1007/s12325-015-0180-x
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发表时间：
2015-01-01
影响因子：
3.8
通讯作者：
Hunter, Rachael
中科院分区：
文献类型：
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作者：
Hunter, Rachael
导言：尽管建议全科医生（gp）延迟呼吸道感染（RTIs）的抗生素处方，但从2010年到2013年，英格兰初级保健的抗生素处方增加了4.1%。c反应蛋白（CRP）即时检测（POCT），例如Afinion （TM）分析仪（Alere Ltd, Stockport， UK）设备，在欧盟的几个国家被广泛使用。研究表明，CRP POCT的使用，无论是单独使用还是与交流训练相结合，都可以减少抗生素处方并改善出现RTI症状的患者的生活质量。本研究的目的是评估CRP POCT治疗RTIs的成本效益，在英国的初级保健中，与标准实践相比，三种不同的护理策略超过3年。方法：进行经济评估，比较三种不同的CRP检测策略（GP + CRP；执业护士+ CRP； GP + CRP和沟通培训）对国家健康与护理卓越研究所指南CG69定义的RTI症状患者的成本和收益，与目前没有CRP检测的标准GP实践进行比较。分析包括决策树和马尔可夫模型来描述质量调整生命年（QALYs）和每100名患者的成本，以及每组抗生素处方和rti的数量。结果：与目前的标准做法相比，GP + CRP和实习护士+ CRP检测策略导致QALYs增加和成本降低，而GP + CRP检测和沟通培训策略导致成本增加和QALYs降低。此外，所有三个CRP组在3年内都减少了抗生素处方和感染。结论：从长远来看，与减少感染相关的成本节约和QALY增加超过了每位患者CRP检测的额外成本。
Introduction: Despite recommendations that general practitioners (GPs) delay antibiotic prescribing for respiratory tract infections (RTIs), antibiotic prescriptions in primary care in England increased by 4.1% from 2010 to 2013. C-reactive protein (CRP) point-of-care tests (POCT), for example, the Afinion (TM) Analyzer (Alere Ltd, Stockport, UK) device, are widely used in several countries in the European Union. Studies suggest that CRP POCT use, either alone or in combination with communication training, reduces antibiotic prescribing and improves quality of life for patients presenting with RTI symptoms. The aim of this study is to evaluate the cost-effectiveness of CRP POCT for RTIs in primary care in England over 3 years for three different strategies of care compared to standard practice.Methods: An economic evaluation was carried out to compare the costs and benefits of three different strategies of CRP testing (GP plus CRP; practice nurse plus CRP; and GP plus CRP and communication training) for patients with RTI symptoms as defined by National Institute for Health and Care Excellence guideline CG69, compared with current standard GP practice without CRP testing. Analysis consisted of a decision tree and Markov model to describe the quality-adjusted life years (QALYs) and cost per 100 patients, together with the number of antibiotic prescriptions and RTIs for each group.Results: Compared with current standard practice, the GP plus CRP and practice nurse plus CRP test strategies result in increased QALYs and reduced costs, while the GP plus CRP testing and communication training strategy is associated with increased costs and reduced QALYs. Additionally, all three CRP arms led to fewer antibiotic prescriptions and infections over 3 years.Conclusion: The additional cost per patient of the CRP test is outweighed by the associated cost savings and QALY increment associated with a reduction in infections in the long term.