Cost-Effectiveness of Test-and-Treat Strategies to Reduce the Antibiotic Prescription Rate for Acute Febrile Illness in Primary Healthcare Clinics in Africa.

Autor: van Dorst PWM; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. w.m.van.dorst@umcg.nl.; Health-Ecore Ltd., Zeist, The Netherlands. w.m.van.dorst@umcg.nl.; Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. w.m.van.dorst@umcg.nl., van der Pol S; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.; Health-Ecore Ltd., Zeist, The Netherlands., Olliaro P; International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK., Dittrich S; FIND, Geneva, Switzerland.; Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.; Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany., Nkeramahame J; FIND, Geneva, Switzerland., Postma MJ; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.; Health-Ecore Ltd., Zeist, The Netherlands.; Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands.; Department of Pharmacology and Therapy, Universitas Airlangga, Surabaya, Indonesia.; Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia., Boersma C; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.; Health-Ecore Ltd., Zeist, The Netherlands.; Department of Management Sciences, Open University, Heerlen, The Netherlands., van Asselt ADI; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jazyk: angličtina
Zdroj: Applied health economics and health policy [Appl Health Econ Health Policy] 2024 Sep; Vol. 22 (5), pp. 701-715. Date of Electronic Publication: 2024 May 25.
DOI: 10.1007/s40258-024-00889-x
Abstrakt: Background: Inappropriate antibiotic use increases selective pressure, contributing to antimicrobial resistance. Point-of-care rapid diagnostic tests (RDTs) would be instrumental to better target antibiotic prescriptions, but widespread implementation of diagnostics for improved management of febrile illnesses is limited.
Objective: Our study aims to contribute to evidence-based guidance to inform policymakers on investment decisions regarding interventions that foster more appropriate antibiotic prescriptions, as well as to address the evidence gap on the potential clinical and economic impact of RDTs on antibiotic prescription.
Methods: A country-based cost-effectiveness model was developed for Burkina Faso, Ghana and Uganda. The decision tree model simulated seven test strategies for patients with febrile illness to assess the effect of different RDT combinations on antibiotic prescription rate (APR), costs and clinical outcomes. The incremental cost-effectiveness ratio (ICER) was expressed as the incremental cost per percentage point (ppt) reduction in APR.
Results: For Burkina Faso and Uganda, testing all patients with a malaria RDT was dominant compared to standard-of-care (SoC) (which included malaria testing). Expanding the test panel with a C-reactive protein (CRP) test resulted in an ICER of $ 0.03 and $ 0.08 per ppt reduction in APR for Burkina Faso and Uganda, respectively. For Ghana, the pairwise comparison with SoC-including malaria and complete blood count testing-indicates that both testing with malaria RDT only and malaria RDT + CRP are dominant.
Conclusion: The use of RDTs for patients with febrile illness could effectively reduce APR at minimal additional costs, provided diagnostic algorithms are adhered to. Complementing SoC with CRP testing may increase clinicians' confidence in prescribing decisions and is a favourable strategy.
(© 2024. The Author(s).)
Databáze: MEDLINE
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