A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.

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...

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Autores: 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
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Recursos:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p17074
Acesso em linha:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17074
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85173012029&doi=10.1186%2fs12887-023-04235-3&partnerID=40&md5=42e98d157fae6bef186e6699ad545619
Access Level:acceso abierto
Palavra-chave:Cost effectiveness
Delayed antibiotic prescription
Paediatrics
Primary care
Respiratory tract infections
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spelling A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.Mas-Dalmau GPérez-Lacasta MJAlonso-Coello PGorrotxategi-Gorrotxategi PArgüelles-Prendes EEspinazo-Ramos OValls-Duran TGonzalo-Alonso MECortés-Viana MPMenéndez-Bada TVázquez-Fernández MEPérez-Hernández AIMuñoz-Ortiz LVillanueva-López CLittle Pde la Poza-Abad MCarles-Lavila MCost effectivenessDelayed antibiotic prescriptionPaediatricsPrimary careRespiratory tract infectionsBACKGROUND: 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).BMC2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17074https://www.scopus.com/inward/record.uri?eid=2-s2.0-85173012029&doi=10.1186%2fs12887-023-04235-3&partnerID=40&md5=42e98d157fae6bef186e6699ad545619BMC PediatricsISSN: 14712431reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p170742026-06-14T12:41:47Z
dc.title.none.fl_str_mv A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.
title A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.
spellingShingle A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.
Mas-Dalmau G
Cost effectiveness
Delayed antibiotic prescription
Paediatrics
Primary care
Respiratory tract infections
title_short 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_sort A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.
dc.creator.none.fl_str_mv 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
author Mas-Dalmau G
author_facet 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
author_role author
author2 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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cost effectiveness
Delayed antibiotic prescription
Paediatrics
Primary care
Respiratory tract infections
topic Cost effectiveness
Delayed antibiotic prescription
Paediatrics
Primary care
Respiratory tract infections
description 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).
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17074
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85173012029&doi=10.1186%2fs12887-023-04235-3&partnerID=40&md5=42e98d157fae6bef186e6699ad545619
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17074
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85173012029&doi=10.1186%2fs12887-023-04235-3&partnerID=40&md5=42e98d157fae6bef186e6699ad545619
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv BMC
publisher.none.fl_str_mv BMC
dc.source.none.fl_str_mv BMC Pediatrics
ISSN: 14712431
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
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