Cost-effectiveness of point-of-care C-reactive protein tests for respiratory tract infection in primary care in England

Abstract

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™ 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.

Fig. 1

Decision tree for current practice and the three CRP test strategies. Decision-making criteria used to evaluate the cost-effectiveness of CRP testing and current practice. CRP C-reactive protein

Fig. 2

Markov model for current practice and the three C-reactive protein test strategies. The Markov model depicts two states: healthy and respiratory tract infection

Fig. 3

Cost-effectiveness plane: current practice compared to GP plus CRP, practice nurse plus CRP, and GP plus CRP and communication training. Three-year time horizon, 100 patients and discounted costs and QALYs. 1,000 iterations. CRP C-reactive protein, GP general practitioner, QALYs quality-adjusted life years

Fig. 4

Cost-effectiveness acceptability curve: current practice compared to GP plus CRP, practice nurse plus CRP, and GP plus CRP and communication training. Three-year time horizon, 100 patients and discounted costs and QALYs. 5,000 iterations. CRP C-reactive protein, GP general practitioner, NMB net monetary benefit, QALYs quality-adjusted life years

Fig. 5

Cost-effectiveness acceptability curve: current practice compared to GP plus CRP. Three-year time horizon, 100 patients and discounted costs and QALYs. 5,000 iterations. CRP C-reactive protein, GP general practitioner, NMB net monetary benefit, QALYs quality-adjusted life years

Fig. 6

Cost-effectiveness acceptability curve: current practice compared to practice nurse plus CRP. Three-year time horizon, 100 patients and discounted costs and QALYs. 5,000 iterations. CRP C-reactive protein, NMB net monetary benefit, QALYs quality-adjusted life years

Fig. 7

Cost-effectiveness acceptability curve: current practice compared to GP plus CRP, practice nurse plus CRP, and GP plus CRP and communication training—9-year time horizon. CRP C-reactive protein, GP general practitioner, NMB net monetary benefit, QALYs quality-adjusted life years