A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.
Por:
Mas-Dalmau G, Pérez-Lacasta MJ, Alonso-Coello P, Gorrotxategi-Gorrotxategi P, Argüelles-Prendes E, Espinazo-Ramos O, Valls-Duran T, Gonzalo-Alonso ME, Cortés-Viana MP, Menéndez-Bada T, Vázquez-Fernández ME, Pérez-Hernández AI, Muñoz-Ortiz L, Villanueva-López C, Little P, de la Poza-Abad M, Carles-Lavila M
Publicada:
2 oct 2023
Ahead of Print:
2 oct 2023
Resumen:
BACKGROUND: Antibiotic prescription for respiratory tract infections (RTIs) in children attending primary care centres is almost double that predicted according to bacterial prevalence. Delayed antibiotic prescription (DAP) is designed to deploy a more rational use of antibiotics. While studies have evaluated DAP efficacy and safety for children with RTIs, little research has been conducted on the economic implications. METHODS: Our trial compared cost-effectiveness for DAP, immediate antibiotic prescription (IAP), and no antibiotic prescription (NAP) for children aged 2-14 years with acute uncomplicated RTIs attended to in 39 primary care centres in Spain. The main outcome was the incremental cost-effectiveness ratio (ICER), measured in euros per gained quality-adjusted life days (QALDs). Net monetary benefit (NMB) was also calculated as a tool for decision making. The analysis was performed from a societal perspective for a time horizon of 30 days, and included healthcare direct costs, non-healthcare direct and indirect costs, and the antimicrobial resistance (AMR) cost. RESULTS: DAP was the most cost-effective strategy, even when the cost of AMR was included. QALD values for the three strategies were very similar. IAP compared to DAP was more costly (109.68 vs 100.90 euros) and similarly effective (27.88 vs 27.94 QALDs). DAP compared to NAP was more costly (100.90 vs 97.48 euros) and more effective (27.94 vs. 27.82 QALDs). The ICER for DAP compared to NAP was 28.84 euros per QALD. The deterministic sensitivity analysis indicated that non-healthcare indirect costs had the greatest impact on the ICER. The cost-effectiveness acceptability curve showed that DAP was the preferred option in approximately 81.75% of Monte Carlo iterations, assuming a willingness-to-pay value of 82.2 euros per gained QALD. CONCLUSIONS: When clinicians are in doubt about whether an antibiotic is needed for children with RTIs attending PC centres, those treated with the DAP strategy will have slightly better efficiency outcomes than those treated with IAP because its costs are lower than those of IAP. DAP is also the most cost-effective strategy over a time horizon of 30 days if AMR is considered, despite higher short-term costs than NAP. However, if in the long term the costs of AMR are larger than estimated, NAP could also be an alternative strategy. TRIAL REGISTRATION: This trial has been registered at www. CLINICALTRIALS: gov (identifier NCT01800747; Date: 28/02/2013 (retrospectively registered).
Filiaciones:
Mas-Dalmau G:
Department of Epidemiology and Public Health - Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
Nursing Care Research Group, IIB Sant Pau, Barcelona, Spain
Pérez-Lacasta MJ:
Department of Economics, Universitat Rovira i Virgili, Reus, Spain
Economic Challenges for the Next Generation (ECO-NEXT: SGR2021-00729), Reus, Spain
Research Centre On Economics and Sustainability (ECO-SOS), Reus, Spain
Alonso-Coello P:
Department of Epidemiology and Public Health - Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Gorrotxategi-Gorrotxategi P:
Pasai San Pedro Primary Care Centre, Pasaia, Spain
Argüelles-Prendes E:
Ribadesella Primary Care Centre, Ribadesella, Spain
Espinazo-Ramos O:
Las Matas Primary Care Centre, Las Rozas de Madrid, Spain
Valls-Duran T:
Val Miñor Primary Care Centre, Nigrán, Spain
Gonzalo-Alonso ME:
Ugao Miraballes Primary Care Centre, Ugao Miraballes, Spain
Arrigorriaga Primary Care Centre, Arrigorriaga, Spain
Ariz-Basauri Primary Care Centre, Basauri, Spain
Cortés-Viana MP:
Maragall Primary Care Centre, Barcelona, Spain
Menéndez-Bada T:
Iruña de Oca Primary Care Centre, Nanclares de la Oca, Spain
Vázquez-Fernández ME:
Arturo Eyries Primary Care Centre, Valladolid, Spain
Pérez-Hernández AI:
Torrelodones Primary Care Centre, Torrelodones, Spain
Muñoz-Ortiz L:
Catalan Agency for Health Quality and Assessment (AQuAS), Barcelona, Spain
Villanueva-López C:
Manso Primary Care Centre, Barcelona, Spain
Little P:
Aldermoor Primary Care Centre, Southampton, UK
de la Poza-Abad M:
Dr Carles Ribas Primary Care Centre, Barcelona, Spain
Carles-Lavila M:
Department of Economics, Universitat Rovira i Virgili, Reus, Spain.
Economic Challenges for the Next Generation (ECO-NEXT: SGR2021-00729), Reus, Spain.
Research Centre On Economics and Sustainability (ECO-SOS), Reus, Spain.
gold, Green Published, All Open Access; Gold
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