Hunter Rachael
Research Department of Primary Care and Population Health, Royal Free Medical School, London, NW3 2PF, UK,
Adv Ther. 2015 Jan;32(1):69-85. doi: 10.1007/s12325-015-0180-x. Epub 2015 Jan 27.
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.
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.
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.
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.
尽管有建议称全科医生（GP）应延迟开具呼吸道感染（RTI）的抗生素处方，但2010年至2013年期间，英国初级医疗保健中的抗生素处方量仍增长了4.1%。例如，C反应蛋白（CRP）即时检验（POCT）设备，如Afinion™分析仪（英国斯托克波特的Alere有限公司），在欧盟的几个国家被广泛使用。研究表明，单独使用CRP POCT或与沟通培训相结合，可减少抗生素处方的开具，并改善出现RTI症状患者的生活质量。本研究的目的是评估在英格兰初级医疗保健中，与标准治疗相比，三种不同治疗策略下CRP POCT用于RTI三年的成本效益。
进行了一项经济学评估，以比较针对英国国家卫生与临床优化研究所指南CG69所定义的有RTI症状患者的三种不同CRP检测策略（全科医生加CRP；执业护士加CRP；以及全科医生加CRP和沟通培训）与当前不进行CRP检测的标准全科医生治疗的成本和效益。分析包括决策树和马尔可夫模型，以描述每100名患者的质量调整生命年（QALY）和成本，以及每组的抗生素处方数量和RTI情况。
与当前标准治疗相比，全科医生加CRP和执业护士加CRP检测策略可提高QALY并降低成本，而全科医生加CRP检测和沟通培训策略则与成本增加和QALY降低相关。此外，所有三个CRP组在三年内导致的抗生素处方和感染数量均减少。
从长期来看，CRP检测每位患者的额外成本被与感染减少相关的成本节约和QALY增加所抵消。
