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CRP testing to guide RTI antibiotics ‘cost-effective’

Use of point-of-care C-reactive protein tests in general practice to cut use of antibiotics for sore throats and coughs would lead to reduced costs and improvements in patients’ quality of life, according to a study modelling the likely impact of the tests.

The research compared usual management of respiratory tract infections (RTIs) in primary care, whereby GPs prescribe antibiotics according to their clinical judgement and patients’ expectations, with an alternative model whereby GPs use a C-reactive protein (CRP) test result to help decide on whether to prescribe antibiotics.

Based on data from clinical trials, and taking into account the costs of the CRP tests, management of RTI and any complications of infections or antibiotics, use of CRP testing cut the total costs of care over a three-year period from £18,081 to £18,039 per 100 patients.

Meanwhile patient quality of life – measured in quality-adjusted life-years (QALYs) – was expected to improve slightly with use of CRP testing compared with usual practice, from 255.63 to 255.77.    

A similar strategy whereby practice nurses carry out the CRP testing was also associated with reduced costs and improved quality of life.

The paper concluded: ‘The data suggest that these strategies are associated with reduced risks of infection and antibiotic prescribing, in combination with increased QALYs, and therefore could be implemented cost-effectively in primary care as a potential strategy to help reduce unnecessary antibiotic prescriptions.’

NICE recently recommended GPs should use point-of-care CRP testing to guide antibiotic use in pneumonia, but GP experts have warned CCGs must invest in practices so they can introduce such testing into frontline care.

The study was carried out by health economist Rachael Hunter, from the Research Department of Primary Care and Population Health at the Royal Free Medical School, with sponsorship from Alere Ltd, the manufacturer of a point-of-care CRP test.

Adv Ther 2015; available online 27 January