A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children
Abstract 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 stud...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Pediatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12887-023-04235-3 |
| _version_ | 1797451461138841600 |
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| author | Gemma Mas-Dalmau María José Pérez-Lacasta Pablo Alonso-Coello Pedro Gorrotxategi-Gorrotxategi Emma Argüelles-Prendes Oscar Espinazo-Ramos Teresa Valls-Duran María Encarnación Gonzalo-Alonso María Pilar Cortés-Viana Tatiana Menéndez-Bada Marta Esther Vázquez-Fernández Ana Isabel Pérez-Hernández Laura Muñoz-Ortiz Carmen Villanueva-López Paul Little Mariam de la Poza-Abad Misericòrdia Carles-Lavila on behalf of the DAP Paediatrics Group |
| author_facet | Gemma Mas-Dalmau María José Pérez-Lacasta Pablo Alonso-Coello Pedro Gorrotxategi-Gorrotxategi Emma Argüelles-Prendes Oscar Espinazo-Ramos Teresa Valls-Duran María Encarnación Gonzalo-Alonso María Pilar Cortés-Viana Tatiana Menéndez-Bada Marta Esther Vázquez-Fernández Ana Isabel Pérez-Hernández Laura Muñoz-Ortiz Carmen Villanueva-López Paul Little Mariam de la Poza-Abad Misericòrdia Carles-Lavila on behalf of the DAP Paediatrics Group |
| author_sort | Gemma Mas-Dalmau |
| collection | DOAJ |
| description | Abstract 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). |
| first_indexed | 2024-03-09T14:54:01Z |
| format | Article |
| id | doaj.art-3308036cc5ec46548d2eee67d158f9c4 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-03-09T14:54:01Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-3308036cc5ec46548d2eee67d158f9c42023-11-26T14:15:44ZengBMCBMC Pediatrics1471-24312023-10-0123111310.1186/s12887-023-04235-3A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in childrenGemma Mas-Dalmau0María José Pérez-Lacasta1Pablo Alonso-Coello2Pedro Gorrotxategi-Gorrotxategi3Emma Argüelles-Prendes4Oscar Espinazo-Ramos5Teresa Valls-Duran6María Encarnación Gonzalo-Alonso7María Pilar Cortés-Viana8Tatiana Menéndez-Bada9Marta Esther Vázquez-Fernández10Ana Isabel Pérez-Hernández11Laura Muñoz-Ortiz12Carmen Villanueva-López13Paul Little14Mariam de la Poza-Abad15Misericòrdia Carles-Lavila16on behalf of the DAP Paediatrics GroupDepartment of Epidemiology and Public Health - Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau (IIB Sant Pau)Department of Economics, Universitat Rovira i VirgiliDepartment of Epidemiology and Public Health - Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau - Biomedical Research Institute Sant Pau (IIB Sant Pau)Pasai San Pedro Primary Care CentreRibadesella Primary Care CentreLas Matas Primary Care CentreVal Miñor Primary Care CentreUgao Miraballes Primary Care CentreMaragall Primary Care CentreIruña de Oca Primary Care CentreArturo Eyries Primary Care CentreTorrelodones Primary Care CentreCatalan Agency for Health Quality and Assessment (AQuAS)Manso Primary Care CentreAldermoor Primary Care CentreDr Carles Ribas Primary Care CentreDepartment of Economics, Universitat Rovira i VirgiliAbstract 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).https://doi.org/10.1186/s12887-023-04235-3Cost effectivenessDelayed antibiotic prescriptionRespiratory tract infectionsPrimary carePaediatrics |
| spellingShingle | Gemma Mas-Dalmau María José Pérez-Lacasta Pablo Alonso-Coello Pedro Gorrotxategi-Gorrotxategi Emma Argüelles-Prendes Oscar Espinazo-Ramos Teresa Valls-Duran María Encarnación Gonzalo-Alonso María Pilar Cortés-Viana Tatiana Menéndez-Bada Marta Esther Vázquez-Fernández Ana Isabel Pérez-Hernández Laura Muñoz-Ortiz Carmen Villanueva-López Paul Little Mariam de la Poza-Abad Misericòrdia Carles-Lavila on behalf of the DAP Paediatrics Group A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children BMC Pediatrics Cost effectiveness Delayed antibiotic prescription Respiratory tract infections Primary care Paediatrics |
| title | A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children |
| title_full | A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children |
| title_fullStr | A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children |
| title_full_unstemmed | A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children |
| title_short | A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children |
| title_sort | trial based cost effectiveness analysis of antibiotic prescription strategies for non complicated respiratory tract infections in children |
| topic | Cost effectiveness Delayed antibiotic prescription Respiratory tract infections Primary care Paediatrics |
| url | https://doi.org/10.1186/s12887-023-04235-3 |
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