tetano
Editor, Senior Moderator
BMJ Glob Health. 2019 Mar 30;4(2):e001291. doi: 10.1136/bmjgh-2018-001291. eCollection 2019.
[h=1]Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka.[/h] Tillekeratne LG[SUP]1,[/SUP][SUP]2[/SUP], Bodinayake C[SUP]3[/SUP], Nagahawatte A[SUP]3[/SUP], Kurukulasooriya R[SUP]4[/SUP], Orlando LA[SUP]1[/SUP], Simmons RA[SUP]2[/SUP], Park LP[SUP]1,[/SUP][SUP]2[/SUP], Woods CW[SUP]1,[/SUP][SUP]2[/SUP], Reed SD[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]Background:[/h] Acute respiratory infections are a common reason for antibiotic overuse. We previously showed that providing Sri Lankan clinicians with positive rapid influenza test results was associated with a reduction in antibiotic prescriptions. The economic impact of influenza diagnostic strategies is unknown.
[h=4]Methods:[/h] We estimated the incremental cost per antibiotic prescription avoided with three diagnostic strategies versus standard care when managing Sri Lankan outpatients with influenza-like illness (ILI): (1) influenza clinical prediction tool, (2) targeted rapid influenza testing and (3) universal rapid influenza testing. We compared findings with literature-based estimates of the cost of antimicrobial resistance attributable to each antibiotic prescription.
[h=4]Results:[/h] Standard care was less expensive than other strategies across all parameter values in one-way sensitivity analyses. The incremental cost per antibiotic prescription avoided with clinical prediction versus standard care was US$3.0, which was lower than the base-case estimate of the cost of antimicrobial resistance per ILI antibiotic prescription (US$12.5). The incremental cost per antibiotic prescription avoided with targeted testing and universal testing versus standard care were both higher than the base-case cost of antimicrobial resistance per ILI antibiotic prescription: US$49.1 and US$138.3, respectively. To obtain a cost-effectiveness ratio lower than US$12.5 with targeted testing versus standard care, the test price must be <US$2.6. At a higher threshold of US$28.7, the test price must be <US$7.7.
[h=4]Conclusion:[/h] Clinical prediction tools and targeted rapid influenza testing may be cost-saving strategies in Sri Lanka when accounting for the societal cost of antimicrobial resistance.
[h=4]KEYWORDS:[/h] diagnostics and tools; health economics
PMID: 30997171 PMCID: PMC6441298 DOI: 10.1136/bmjgh-2018-001291
[h=1]Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka.[/h] Tillekeratne LG[SUP]1,[/SUP][SUP]2[/SUP], Bodinayake C[SUP]3[/SUP], Nagahawatte A[SUP]3[/SUP], Kurukulasooriya R[SUP]4[/SUP], Orlando LA[SUP]1[/SUP], Simmons RA[SUP]2[/SUP], Park LP[SUP]1,[/SUP][SUP]2[/SUP], Woods CW[SUP]1,[/SUP][SUP]2[/SUP], Reed SD[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]Background:[/h] Acute respiratory infections are a common reason for antibiotic overuse. We previously showed that providing Sri Lankan clinicians with positive rapid influenza test results was associated with a reduction in antibiotic prescriptions. The economic impact of influenza diagnostic strategies is unknown.
[h=4]Methods:[/h] We estimated the incremental cost per antibiotic prescription avoided with three diagnostic strategies versus standard care when managing Sri Lankan outpatients with influenza-like illness (ILI): (1) influenza clinical prediction tool, (2) targeted rapid influenza testing and (3) universal rapid influenza testing. We compared findings with literature-based estimates of the cost of antimicrobial resistance attributable to each antibiotic prescription.
[h=4]Results:[/h] Standard care was less expensive than other strategies across all parameter values in one-way sensitivity analyses. The incremental cost per antibiotic prescription avoided with clinical prediction versus standard care was US$3.0, which was lower than the base-case estimate of the cost of antimicrobial resistance per ILI antibiotic prescription (US$12.5). The incremental cost per antibiotic prescription avoided with targeted testing and universal testing versus standard care were both higher than the base-case cost of antimicrobial resistance per ILI antibiotic prescription: US$49.1 and US$138.3, respectively. To obtain a cost-effectiveness ratio lower than US$12.5 with targeted testing versus standard care, the test price must be <US$2.6. At a higher threshold of US$28.7, the test price must be <US$7.7.
[h=4]Conclusion:[/h] Clinical prediction tools and targeted rapid influenza testing may be cost-saving strategies in Sri Lanka when accounting for the societal cost of antimicrobial resistance.
[h=4]KEYWORDS:[/h] diagnostics and tools; health economics
PMID: 30997171 PMCID: PMC6441298 DOI: 10.1136/bmjgh-2018-001291