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. 2018 Oct 4:7:119.
doi: 10.1186/s13756-018-0414-1. eCollection 2018.

C-reactive protein point of care testing in the management of acute respiratory infections in the Vietnamese primary healthcare setting - a cost benefit analysis

Yoel Lubell  1   2 , Nga T T Do  3 , Kinh V Nguyen  4 , Ngan T D Ta  4 , Ninh T H Tran  4 , Hung M Than  4 , Long B Hoang  3 , Poojan Shrestha  1   5 , Rogier H van Doorn  1   3 , Behzad Nadjm  1   3 , Heiman F L Wertheim  1   3   6
Affiliations

C-reactive protein point of care testing in the management of acute respiratory infections in the Vietnamese primary healthcare setting - a cost benefit analysis

Yoel Lubell et al. Antimicrob Resist Infect Control. .

Abstract

Aim: We assess the cost-benefit implications of C-reactive protein (CRP) testing in reducing antibiotic prescription for acute respiratory infection in Viet Nam by comparing the incremental costs of CRP testing with the economic costs of antimicrobial resistance averted due to lower antibiotic prescribing.

Findings: Patients in the CRP group and the controls incurred similar costs in managing their illness, excluding the costs of the quantitative CRP tests, provided free of charge in the trial context. Assuming a unit cost of $1 per test, the incremental cost of CRP testing was $0.93 per patient. Based on a previous modelling analysis, the 20 percentage point reduction in prescribing observed in the trial implies a societal benefit of $0.82 per patient. With the low levels of adherence to the test results observed in the trial, CRP testing would not be cost-beneficial. The sensitivity analyses showed, however, that with higher adherence to test results their use would be cost-beneficial.

Keywords: Antibiotic; C- reactive protein; Cost-benefit; Primary care; Vietnam.

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Conflict of interest statement

The trial was approved by the ethical committees of the National Hospital for Tropical Diseases in Hanoi (39/IRB-NHTD) and the Oxford University Tropical Research Ethics Committee (OxTREC Reference: 176–12). Permission for this study also was obtained from local authorities. Patients who fulfilled the inclusion criteria were asked to participate by signing the consent form. The cost surveys were included in these approvals and consent procedures. The trial is registered at ClinicalTrials.gov under number NCT01918579.Not applicable.All authors have no competing interests to declare.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Net benefit for CRP testing by unit cost, test adherence, and cost of AMR. The 3 panels indicate the net-benefit of CRP testing in response to different configurations of the cost of the CRP test, the degree to which health workers adhere with the test results, and the economic cost of AMR per full course of antibiotic averted. The range of colours reflect the net-benefit of the CRP tests, with dark orange areas indicating instances where the use of the test is not cost-beneficial, and dark green areas where the test is most-cost-beneficial. With the exclusion of the costs of AMR ($0), a CRP test would be at best cost-neutral if it was low cost. With the inclusion of the costs of AMR, using either the baseline estimate of $4.1 or a higher estimate of $14, CRP testing would be cost-benficial even if the cost of the test was as high as $3, providing adherence with test results was high
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