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. 2013 Jul;63(612):e465-71.
doi: 10.3399/bjgp13X669185.

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

Raymond Oppong  1 , Mark Jit, Richard D Smith, Christopher C Butler, Hasse Melbye, Sigvard Mölstad, Joanna Coast
Affiliations

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

Raymond Oppong et al. Br J Gen Pract. 2013 Jul.

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.

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Figures

Figure 1
Figure 1
Incremental net benefits (INB) of CRP versus no CRP (95% CI).
Figure 2
Figure 2
Cost-effectiveness acceptability curve. CRP = C-reactive protein.
See this image and copyright information in PMC

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