title: Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions.
abstract: BACKGROUND
  Point-of-care C-reactive protein (POCCRP) is a biomarker of inflammation that offers clinicians a rapid POC test to guide antibiotic prescribing decisions for acute cough and lower respiratory tract infections (LRTI). However, evidence that POCCRP is cost-effective is limited, particularly outside experimental settings.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of POCCRP as a diagnostic tool for acute cough and LRTI from the perspective of the health service.
  
  
  METHODS
  Observational study of the presentation, management, and outcomes of patients with acute cough and LRTI in primary care settings in Norway and Sweden.
  
  
  METHODS
  Using hierarchical regression, data were analysed in terms of the effect on antibiotic use, cost, and patient outcomes (symptom severity after 7 and 14 days, time to recovery, and EQ-5D), while controlling for patient characteristics (self-reported symptom severity, comorbidities, and health-related quality of life) at first attendance.
  
  
  RESULTS
  POCCRP testing is associated with non-significant positive reductions in antibiotic prescribing (P = 0.078) and increased cost (P = 0.092). Despite the uncertainty, POCCRP testing is also associated with a cost per quality-adjusted life year (QALY) gain of €9391. At a willingness-to-pay threshold of €30,000 per QALY gained, there is a 70% probability of CRP being cost-effective.
  
  
  CONCLUSIONS
  POCCRP testing is likely to provide a cost-effective diagnostic intervention both in terms of reducing antibiotic prescribing and in terms of QALYs gained.
authors.affiliation: Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham. r.a.oppong@bham.ac.uk
authors.forename: Raymond
authors.initials: R
authors.lastname: Oppong
authors.forename: Mark
authors.initials: M
authors.lastname: Jit
authors.forename: Richard D
authors.initials: RD
authors.lastname: Smith
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.forename: Hasse
authors.initials: H
authors.lastname: Melbye
authors.forename: Sigvard
authors.initials: S
authors.lastname: Mölstad
authors.forename: Joanna
authors.initials: J
authors.lastname: Coast
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D019095:Point-of-Care Systems / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics; D011320:Primary Health Care / Q000191:economics; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002097:C-Reactive Protein