Using point-of-care diagnostic testing for improved antibiotic prescription: an economic model.
Using point-of-care diagnostic testing for improved antibiotic prescription: an economic model.
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使用床旁诊断测试改善抗生素处方：一个经济模型。
DOI：
10.1186/s13561-021-00326-y
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发表时间：
2021-08-09
影响因子：
2.4
通讯作者：
Rodríguez-Ibeas R
中科院分区：
文献类型：
--
作者：
Antoñanzas F;Juárez-Castelló CA;Rodríguez-Ibeas R
抗生素被过度开出用于治疗传染病，并产生了抗菌素耐药性，从而降低了它们的有效性。遵循个性化医学新范式背后的基本原理，护理点诊断检测(POCT)被提出以提高抗生素处方的质量，目的是减少抗菌素耐药性。为了了解这一建议是否有效，我们建立了一个理论经济模型来确定在哪些条件下使用POCT指导抗生素处方的预期收益大于经验处方，其中预期收益定义为健康的经济价值与治疗成本之间的差额。我们考虑了一群医生之间的相互作用，他们在向一家销售诊断设备的公司开处方时表现出不同程度的不确定性，并分析了公司的定价政策和医生的处方决定。我们允许医生将抗菌素耐药性的外部成本内部化。我们发现POCT的使用减少了抗生素处方的数量。当医生将抗菌素耐药性的成本内部化时，抗生素处方的减少幅度更大。不确定性水平相对较高的医生使用POCT，因为他们不确定对大部分患者进行正确的治疗。不确定性水平较低的医生更喜欢凭经验开出处方。对于POCT的吸收，医生群体中的细分取决于不确定程度在医生中的分布。对于每一次测试，该公司都会收取管理测试所需投入的边际生产成本，并从测试设备的销售中获利。从理论上看，我们的发现证实了POCT提高了抗生素处方的质量，减少了处方数量的事实。然而，它们的使用并不总是被推荐的，因为当不确定性较低时，经验疗法可能是首选。
Antibiotics have been overprescribed to treat infectious diseases and have generated antimicrobial resistances that reduce their effectiveness. Following the rationale behind the new paradigm of personalized medicine, point-of-care diagnostic testing (POCT) has been proposed to improve the quality of antibiotic prescription with the aim of reducing antimicrobial resistances. In order to understand whether this recommendation is valid, we create a theoretical economic model to determine under which conditions the expected benefits of using POCT to guide antibiotic prescription are greater than for empiric prescription, where we define the expected benefits as the difference between the economic value of health and the costs of the treatment. We consider the interaction of a group of physicians who express differing levels of uncertainty when prescribing with a firm selling a diagnostic device, and analyse the firm’s pricing policy and the physicians’ prescribing decisions. We allow the physicians to internalize the external costs of antimicrobial resistances. We find that the use of POCT reduces the number of antibiotic prescriptions. The reduction in antibiotic prescriptions is higher when physicians internalise the costs of antimicrobial resistances. Physicians with relatively high levels of uncertainty use POCT as they are uncertain about the right treatment for a large proportion of patients. Physicians with low levels of uncertainty prefer to prescribe empirically. The segmentation in the population of physicians regarding the uptake of POCT depends on the distribution of levels of uncertainty across physicians. For each test, the firm charges the marginal production costs of the inputs needed to administer the test, and makes its profit from the sales of the testing devices. From a theoretical perspective, our findings corroborate the fact that POCT improve the quality of antibiotic prescription and reduce the number of prescriptions. Nevertheless, their use is not always recommended as empiric therapy may be preferred when uncertainty is low.
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