A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children
Mas Dalmau, Gemma (Institut d'Investigació Biomèdica Sant Pau)
Pérez-Lacasta, M.J. (Universitat Rovira i Virgili)
Alonso-Coello, Pablo (Institut d'Investigació Biomèdica Sant Pau)
Gorrotxategi-Gorrotxategi, P. (Ambulatorio de Pasai San Pedro)
Argüelles-Prendes, E. (Centro de Salud de Ribadesella)
Espinazo-Ramos, O. (Centro de Atención Primaria Las Matas)
Valls-Duran, T. (Centro de Atención Primaria Val Miñor)
Gonzalo-Alonso, M.E. (Centro de Atención Primaria Ariz-Basauri)
Cortés-Viana, M.P. (Centro de Atención Primaria Maragall)
Menéndez-Bada, T. (Centro de Atención Primaria Iruña de Oca)
Vázquez-Fernández, M.E. (Centro de Atención Primaria Arturo Eyries)
Pérez-Hernández, A.I. (Centro de Atención Primaria de Torrelodones)
Muñoz-Ortiz, Laura (Agència de Qualitat i Avaluació Sanitàries de Catalunya)
Villanueva-López, C. (Institut Català de la Salut. Centre d'Atenció Primària Manso)
Little, P. (Centro de atención primaria Aldermoor)
Poza Abad, Mariam de la (Centro de Atención Primaria Dr. Carles Ribas)
Carles-Lavila, Misericòrdia (Universitat Rovira i Virgili)
Manuel-Enguidanos, J. (Centro de Atención Primaria Las Matas)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	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. 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. 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).
Ajuts:	Ministerio de Ciencia e Innovación PI11/02192
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cost effectiveness ; Delayed antibiotic prescription ; Paediatrics ; Primary care ; Respiratory tract infections
Publicat a:	BMC Pediatrics, Vol. 23 Núm. 1 (december 2023) , p. 497, ISSN 1471-2431

DOI: 10.1186/s12887-023-04235-3
PMID: 37784098

13 p, 1.7 MB

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