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Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individuall...

Berni Sewell, Nick Francis Orcid Logo, Shaun Harris Orcid Logo, David Gillespie Orcid Logo, Janine Bates Orcid Logo, Patrick White Orcid Logo, Mohammed Fasihul Alam Orcid Logo, Kerenza Hood, Christopher C Butler Orcid Logo, Deborah Fitzsimmons Orcid Logo

BMJ Open, Volume: 14, Issue: 11, Start page: e084144

Swansea University Authors: Berni Sewell, Shaun Harris Orcid Logo, Deborah Fitzsimmons Orcid Logo

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DOI (Published version): 10.1136/bmjopen-2024-084144

Abstract

Objectives: Many patients presenting with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in primary care do not benefit from antibiotics. Excessive use wastes resources, promotes antimicrobial resistance and can harm patients. Design: We conducted a within-trial economic evalu...

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Published in: BMJ Open
ISSN: 2044-6055
Published: BMJ 2024
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Excessive use wastes resources, promotes antimicrobial resistance and can harm patients. Design: We conducted a within-trial economic evaluation, using a UK National Health Service perspective, as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial. Setting: Participating general practices in primary care. Participants: PACE included 324 and 325 consenting participants presenting with AECOPD in the usual-care and CRP-guided groups, respectively. Intervention: We assessed the cost-effectiveness (CE) of a C-reactive protein point-of-care-test (CRP-POCT) in addition to usual clinical assessment to guide antibiotic prescribing for AECOPD in primary care. Primary and secondary outcome measures: A cost-effectiveness analysis (CEA) of incremental cost per 1% antibiotic consumption reduction at 4&#x2009;weeks and a cost-utility analysis (CUA) at 6&#x2009;months were performed, based on a modified intention-to-treat population. Sensitivity analyses assessed the impact of uncertainty on the results. CE acceptability curves represent the probability of CRP-POCT being cost-effective at different willingness-to-pay (WTP) thresholds. Results: Both groups had similar clinical outcomes, but a 20% absolute reduction in antibiotic consumption was observed in the CRP-guided group. CRP-POCT costs of &#xA3;11.31 per test were largely offset by savings in healthcare resource use related to COPD. The mean incremental CE ratios of CRP-POCT were &#xA3;120 per 1% absolute reduction in antibiotic consumption at 4 weeks and &#xA3;1054 per quality-adjusted life-year (QALY) gained at 6 months. Sensitivity analysis showed that the CEA results were most affected by changes in healthcare costs, while CUA was sensitive due to marginal differences in costs and outcomes. There is a 73% probability of CRP-POCT being cost-effective at WTP &#x2264;&#xA3;20&#x2009;000 per QALY gained. 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spelling 2024-12-16T12:43:35.7983701 v2 68188 2024-11-06 Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial f6a4af2cfa4275d2a8ebba292fa14421 Berni Sewell Berni Sewell true false 10b1bd08dbad1f2681ff1e527af9f9a3 0000-0001-7724-6621 Shaun Harris Shaun Harris true false e900d99a0977beccf607233b10c66b43 0000-0002-7286-8410 Deborah Fitzsimmons Deborah Fitzsimmons true false 2024-11-06 Objectives: Many patients presenting with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in primary care do not benefit from antibiotics. Excessive use wastes resources, promotes antimicrobial resistance and can harm patients. Design: We conducted a within-trial economic evaluation, using a UK National Health Service perspective, as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial. Setting: Participating general practices in primary care. Participants: PACE included 324 and 325 consenting participants presenting with AECOPD in the usual-care and CRP-guided groups, respectively. Intervention: We assessed the cost-effectiveness (CE) of a C-reactive protein point-of-care-test (CRP-POCT) in addition to usual clinical assessment to guide antibiotic prescribing for AECOPD in primary care. Primary and secondary outcome measures: A cost-effectiveness analysis (CEA) of incremental cost per 1% antibiotic consumption reduction at 4 weeks and a cost-utility analysis (CUA) at 6 months were performed, based on a modified intention-to-treat population. Sensitivity analyses assessed the impact of uncertainty on the results. CE acceptability curves represent the probability of CRP-POCT being cost-effective at different willingness-to-pay (WTP) thresholds. Results: Both groups had similar clinical outcomes, but a 20% absolute reduction in antibiotic consumption was observed in the CRP-guided group. CRP-POCT costs of £11.31 per test were largely offset by savings in healthcare resource use related to COPD. The mean incremental CE ratios of CRP-POCT were £120 per 1% absolute reduction in antibiotic consumption at 4 weeks and £1054 per quality-adjusted life-year (QALY) gained at 6 months. Sensitivity analysis showed that the CEA results were most affected by changes in healthcare costs, while CUA was sensitive due to marginal differences in costs and outcomes. There is a 73% probability of CRP-POCT being cost-effective at WTP ≤£20 000 per QALY gained. Conclusion: CRP-POCT is a cost-effective intervention for safely reducing antibiotic consumption in patients with AECOPD.Trial registration number ISRCTN24346473 Journal Article BMJ Open 14 11 e084144 BMJ 2044-6055 27 11 2024 2024-11-27 10.1136/bmjopen-2024-084144 COLLEGE NANME COLLEGE CODE Swansea University SU Library paid the OA fee (TA Institutional Deal) National Institute for Health and Care Research Health Technology Assessment programme - 12/33/12 2024-12-16T12:43:35.7983701 2024-11-06T09:48:05.4557527 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Berni Sewell 1 Nick Francis 0000-0001-8939-7312 2 Shaun Harris 0000-0001-7724-6621 3 David Gillespie 0000-0002-6934-2928 4 Janine Bates 0000-0003-3610-2415 5 Patrick White 0000-0002-2047-8787 6 Mohammed Fasihul Alam 0000-0003-2590-851x 7 Kerenza Hood 8 Christopher C Butler 0000-0002-0102-3453 9 Deborah Fitzsimmons 0000-0002-7286-8410 10
title Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial
spellingShingle Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial
Berni Sewell
Shaun Harris
Deborah Fitzsimmons
title_short Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial
title_full Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial
title_fullStr Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial
title_full_unstemmed Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial
title_sort Cost-effectiveness of C-reactive protein point of care testing for safely reducing antibiotic consumption for acute exacerbations of chronic obstructive pulmonary disease as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial
author_id_str_mv f6a4af2cfa4275d2a8ebba292fa14421
10b1bd08dbad1f2681ff1e527af9f9a3
e900d99a0977beccf607233b10c66b43
author_id_fullname_str_mv f6a4af2cfa4275d2a8ebba292fa14421_***_Berni Sewell
10b1bd08dbad1f2681ff1e527af9f9a3_***_Shaun Harris
e900d99a0977beccf607233b10c66b43_***_Deborah Fitzsimmons
author Berni Sewell
Shaun Harris
Deborah Fitzsimmons
author2 Berni Sewell
Nick Francis
Shaun Harris
David Gillespie
Janine Bates
Patrick White
Mohammed Fasihul Alam
Kerenza Hood
Christopher C Butler
Deborah Fitzsimmons
format Journal article
container_title BMJ Open
container_volume 14
container_issue 11
container_start_page e084144
publishDate 2024
institution Swansea University
issn 2044-6055
doi_str_mv 10.1136/bmjopen-2024-084144
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 0
active_str 0
description Objectives: Many patients presenting with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in primary care do not benefit from antibiotics. Excessive use wastes resources, promotes antimicrobial resistance and can harm patients. Design: We conducted a within-trial economic evaluation, using a UK National Health Service perspective, as part of the multicentre, parallel-arm, open, individually randomised, controlled PACE trial. Setting: Participating general practices in primary care. Participants: PACE included 324 and 325 consenting participants presenting with AECOPD in the usual-care and CRP-guided groups, respectively. Intervention: We assessed the cost-effectiveness (CE) of a C-reactive protein point-of-care-test (CRP-POCT) in addition to usual clinical assessment to guide antibiotic prescribing for AECOPD in primary care. Primary and secondary outcome measures: A cost-effectiveness analysis (CEA) of incremental cost per 1% antibiotic consumption reduction at 4 weeks and a cost-utility analysis (CUA) at 6 months were performed, based on a modified intention-to-treat population. Sensitivity analyses assessed the impact of uncertainty on the results. CE acceptability curves represent the probability of CRP-POCT being cost-effective at different willingness-to-pay (WTP) thresholds. Results: Both groups had similar clinical outcomes, but a 20% absolute reduction in antibiotic consumption was observed in the CRP-guided group. CRP-POCT costs of £11.31 per test were largely offset by savings in healthcare resource use related to COPD. The mean incremental CE ratios of CRP-POCT were £120 per 1% absolute reduction in antibiotic consumption at 4 weeks and £1054 per quality-adjusted life-year (QALY) gained at 6 months. Sensitivity analysis showed that the CEA results were most affected by changes in healthcare costs, while CUA was sensitive due to marginal differences in costs and outcomes. There is a 73% probability of CRP-POCT being cost-effective at WTP ≤£20 000 per QALY gained. Conclusion: CRP-POCT is a cost-effective intervention for safely reducing antibiotic consumption in patients with AECOPD.Trial registration number ISRCTN24346473
published_date 2024-11-27T14:38:11Z
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