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Abstract
Objectives C-reactive protein point-of-care testing (CRP POCT) is a promising diagnostic tool to guide antibiotic prescribing for lower respiratory tract infections (LRTI) in nursing home residents. This study aimed to evaluate cost-effectiveness and return-on-investment (ROI) of CRP POCT compared with usual care for nursing home residents with suspected LRTI from a healthcare perspective.
Design Economic evaluation alongside a cluster randomised, controlled trial.
Setting 11 Dutch nursing homes.
Participants 241 nursing home residents with a newly suspected LRTI.
Intervention Nursing home access to CRP POCT (POCT-guided care) was compared with usual care without CRP POCT (usual care).
Main outcome measures The primary outcome measure for the cost-effectiveness analysis was antibiotic prescribing at initial consultation, and the secondary outcome was full recovery at 3 weeks. ROI analyses included intervention costs, and benefits related to antibiotic prescribing. Three ROI metrics were calculated: Net Benefits, Benefit-Cost-Ratio and Return-On-Investment.
Results In POCT-guided care, total costs were on average €32 higher per patient, the proportion of avoided antibiotic prescribing was higher (0.47 vs 0.18; 0.30, 95% CI 0.17 to 0.42) and the proportion of fully recovered patients statistically non-significantly lower (0.86 vs 0.91; −0.05, 95% CI −0.14 to 0.05) compared with usual care. On average, an avoided antibiotic prescription was associated with an investment of €137 in POCT-guided care compared with usual care. Sensitivity analyses showed that results were relatively robust. Taking the ROI metrics together, the probability of financial return was 0.65.
Conclusion POCT-guided care effectively reduces antibiotic prescribing compared with usual care without significant effects on recovery rates, but requires an investment. Future studies should take into account potential beneficial effects of POCT-guided care on costs and health outcomes related to antibiotic resistance.
Trial registration number NL5054.
- GERIATRIC MEDICINE
- HEALTH ECONOMICS
- INFECTIOUS DISEASES
- Respiratory infections
Data availability statement
Data are available upon reasonable request. The data sets generated and/or analysed during the current study will be deposited in the repository DANS (EASY) after publication of the research results, within a maximum of 9 months post study termination. The data set(s) involved will be pseudonymised and can be accessed under restrictions.
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Data availability statement
Data are available upon reasonable request. The data sets generated and/or analysed during the current study will be deposited in the repository DANS (EASY) after publication of the research results, within a maximum of 9 months post study termination. The data set(s) involved will be pseudonymised and can be accessed under restrictions.
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Footnotes
Contributors MEA, JEB, LWvB, MWvT and TMB contributed to the statistical analysis plan. TMB and MEA performed the cost calculations. MEA performed the statistical analyses, and Johanna Maria van Dongen contributed to the syntax of the return-on-investment analyses. TMB and MEA drafted the manuscript. All authors contributed to the final version of the manuscript. All authors have read and approved the manuscript. TMB and JEB accept responsibility for the overall content as guarantors.
Funding This work was supported by The Netherlands Organisation for Health Research and Development (ZonMw, programme Antibiotic Resistance, grant number 541001 004). Orion Diagnostica and Saltro made in total 20 C-reactive protein point-of-care testing instruments available for the study. The funding bodies have no role in the design of the study, data collection, data analysis, interpretation nor in writing the manuscript or authority over any of these activities.
Competing interests The authors declare: LWvB, TMB, MEA, JB and CMPMH report a grant from The Netherlands Organisation for Health Research and Development (ZonMw), for the conduct of the current study. RH receives no support from any organisation for the submitted work. MWvT reports grants from The Netherlands Organisation for Health Research and Development (ZonMw), outside the submitted work. TJMV reports grants from Abbott, Becton Dickinson, Biomerieux, European Commission; grants from European Commission, Orion, during the conduct of the study; grants from European Commission, Janssen Pharmaceuticals; and grants from ZonMw, outside the submitted work.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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