Cost-effectiveness analysis of a GP- and parent-directed intervention to reduce antibiotic prescribing for children with respiratory tract infections in primary care
Cost-effectiveness analysis of a GP- and parent-directed intervention to reduce antibiotic prescribing for children with respiratory tract infections in primary care
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DOI：
10.1093/jac/dky552
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发表时间：
2019-04-01
影响因子：
5.2
通讯作者：
van Giessen, Anoukh
中科院分区：
文献类型：
--
作者：
Dekker, Anne R. J.;van der Velden, Alike W.;van Giessen, Anoukh
目的评价儿童合理使用抗生素(RAAK)干预措施(全科医生在线培训和家长资料手册)的成本和效果，旨在减少呼吸道感染(RTI)患儿抗生素处方的使用。我们包括向RTI咨询全科医生的儿童，他们的父母为他们保留了两周的(费用)日记。抗生素处方率是指在指数会诊时和随访的2周内儿童获得抗生素处方的百分比。计算干预组和常规护理组之间抗生素处方每减少一个百分比的成本差异。结果干预组153名儿童和常规保育组107名儿童的成本和效果均可用于分析。与常规护理组相比，干预组抗生素处方减少了12%，费用增加了10.27欧元。这导致抗生素处方每减少一个百分比，成本-效果比就增加0.85欧元。干预效果更好但费用更高的概率为53%，而与常规护理相比更有效且费用更低的概率为41%。结论全科医生在线培训和家长资料手册以极低的成本减少了呼吸道感染儿童的抗生素处方，因此应考虑在初级保健中实施。
Objectives We evaluated costs and effects of the RAAK (RAtional Antibiotic use Kids) intervention (GP online training and information booklets for parents), aiming to reduce antibiotic prescribing for children with respiratory tract infection (RTI).Methods We conducted a trial-based cost-effectiveness analysis from a societal perspective. We included children consulting the GP with RTI for whom parents kept a 2week (cost) diary. The antibiotic prescribing rate was the percentage of children receiving an antibiotic prescription at the index consultation and during the 2weeks of follow-up. The cost difference between the intervention and usual care groups per percentage decrease in antibiotic prescribing was calculated. Bootstrapping was used to assess uncertainty surrounding the outcomes.Results Costs and effects of 153 children in the intervention group and 107 children in the usual care group were available for analysis. Antibiotic prescribing was 12% lower in the intervention group and costs were Euro10.27 higher in the intervention group compared with the usual care group. This resulted in an incremental cost-effectiveness ratio of Euro0.85 per percentage decrease in antibiotic prescribing. The probability that the intervention was more effective, but more expensive, was 53%, whereas the probability that the intervention was more effective and less expensive compared with usual care was 41%.Conclusions The online training for GPs and the information booklet for parents resulted in a decrease in antibiotic prescribing in children with RTI, at very low cost, and should therefore be considered for implementation in primary care.