PMID- 32259465
OWN - NLM
STAT- MEDLINE
DCOM- 20210511
LR  - 20210511
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 23
IP  - 7
DP  - 2020 Jul
TI  - Application of a simple point-of-care test to reduce UK healthcare costs and 
      adverse events in outpatient acute respiratory infections.
PG  - 673-682
LID - 10.1080/13696998.2020.1736872 [doi]
AB  - Background: Acute respiratory infection (ARI) accounts for over two-thirds of 
      total antibiotic prescriptions although most are caused by viruses that do not 
      benefit from antibiotics. Most antibiotics are prescribed in the outpatients 
      setting. Antibiotic overuse leads to antibiotic-related adverse events (AEs), 
      inclusive of secondary infections, resistance, and increased costs. Point-of-care 
      tests (POCT) may reduce unnecessary antibiotics. A cost analysis was performed to 
      assess diagnostic POCT options to identify patients with an ARI that may benefit 
      from antibiotics in a United Kingdom (UK) outpatient setting.Methods: Healthcare 
      savings were estimated using a budget impact analysis based on UK National 
      Institute for Health and Care Excellence (NICE) data and direct costs 
      (antibiotics, AEs, POCTs) derived from published literature. Otitis media, 
      sinusitis, pharyngitis and bronchitis were considered the most common ARIs. 
      Antibiotic-related AE costs were calculated using re-consultation costs for 
      anaphylaxis, Stevens-Johnson syndrome, allergies/diarrhea/nausea, C. difficile 
      infection (CDI). Potential cost-savings from POCTs was assessed by evaluating 
      NICE guideline-referenced POCTs (CRP, FebriDx, Sarasota, FL) as well as a target 
      product profile (TPP).Results: Fifty-percent (7,718,283) of ARI consultations 
      resulted in antibiotics while guideline-based prescribing suggest appropriate 
      antibiotic prescriptions are warranted 9% (1,444,877) of ARI consultations. 
      Direct antibiotic costs for actual ARI consultations associated with antibiotics 
      was  pound24,003,866 vs.  pound4,493,568 for guideline-based, "appropriate" antibiotic 
      prescriptions. Antibiotic-related AEs and re-consultations for actual vs. 
      appropriate prescribing totaled  pound302,496,486 vs.  pound63,854,269. ARI prescribing 
      plus AE costs totaled  pound326,729,943 annually without the use of delayed 
      prescribing practices or POCT while the addition of delayed prescribing plus POCT 
      totaled  pound60,114,564- pound78,148,933 depending on the POCT.Conclusions: Adding POCT to 
      outpatient triage of ARI can reduce unnecessary antibiotics and 
      antibiotic-related AEs, resulting in substantial cost savings. Further, near 
      patient diagnostic testing can benefit health systems and patients by avoiding 
      exposure to unnecessary drugs, side effects and antibiotic resistant 
      pathogens.Key points for decision makersMany patients are unnecessarily treated 
      with antibiotics for respiratory infections.Antibiotic misuse leads to 
      unnecessary adverse events, secondary infections, re-consultations, antimicrobial 
      resistance and increased costs.Point-of-care diagnostic tests used to guide 
      antibiotic prescriptions will avoid unnecessary adverse health effects and 
      expenses.
FAU - Schneider, John E
AU  - Schneider JE
AUID- ORCID: 0000-0002-7870-5639
AD  - Avalon Health Economics LLC, Morristown, NJ, USA.
FAU - Boehme, Catharina
AU  - Boehme C
AUID- ORCID: 0000-0002-2200-8674
AD  - FIND (Foundation for Innovative New Diagnostic), Geneva, Switzerland.
FAU - Borisch, Bettina
AU  - Borisch B
AUID- ORCID: 0000-0002-9902-324X
AD  - Institute for Global Health, University Geneva, Geneva, Switzerland.
FAU - Dittrich, Sabine
AU  - Dittrich S
AUID- ORCID: 0000-0002-4522-2788
AD  - FIND (Foundation for Innovative New Diagnostic), Geneva, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20200407
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Anti-Bacterial Agents/adverse effects/therapeutic use
MH  - Antimicrobial Stewardship/*methods
MH  - *Cost Savings
MH  - Databases, Factual
MH  - Humans
MH  - *Outpatients
MH  - Point-of-Care Testing/*economics
MH  - Respiratory Tract Infections/*diagnosis/drug therapy
MH  - United Kingdom
OTO - NOTNLM
OT  - Acute respiratory infection
OT  - C-reactive protein (CRP)
OT  - C53
OT  - FebriDx
OT  - I15
OT  - I19
OT  - antibiotic-related adverse events
OT  - host response biomarkers
OT  - myxovirus resistance protein A (MxA)
OT  - point-of-care tests (POCT)
EDAT- 2020/04/08 06:00
MHDA- 2021/05/12 06:00
CRDT- 2020/04/08 06:00
PHST- 2020/04/08 06:00 [pubmed]
PHST- 2021/05/12 06:00 [medline]
PHST- 2020/04/08 06:00 [entrez]
AID - 10.1080/13696998.2020.1736872 [doi]
PST - ppublish
SO  - J Med Econ. 2020 Jul;23(7):673-682. doi: 10.1080/13696998.2020.1736872. Epub 2020 
      Apr 7.