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

  • Identification data

    Identifier: imarina:9330543
    Handle: https://hdl.handle.net/20.500.11797/imarina9330543
    Authors:
    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 MDAP Paediatrics Group
    Abstract:
    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.W

  • Others:

    Author, as appears in the article.: 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; DAP Paediatrics Group
    Department: Economia
    URV's Author/s: Carles Lavila, Misericòrdia / Pérez Lacasta, Maria José
    Keywords: Respiratory tract infections Primary care Paediatrics Delayed antibiotic prescription Cost effectiveness
    Abstract: 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.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.This trial has been registered at www.gov (identifier NCT01800747; Date: 28/02/2013 (retrospectively registered).© 2023. BioMed Central Ltd., part of Springer Nature.
    Thematic Areas: Saúde coletiva Psicología Planejamento urbano e regional / demografia Pediatrics, perinatology and child health Pediatrics Odontología Nutrição Medicina iii Medicina ii Medicina i Interdisciplinar Farmacia Ensino Engenharias ii Enfermagem Educação física Ciências biológicas iii Ciências biológicas ii Ciências biológicas i Ciências ambientais Ciência de alimentos Biotecnología
    licence for use: https://creativecommons.org/licenses/by/3.0/es/
    Author's mail: mariajose.perez@urv.cat misericordia.carles@urv.cat
    Author identifier: 0000-0001-5906-5632 0000-0003-3796-3014
    Record's date: 2024-08-03
    Papper version: info:eu-repo/semantics/publishedVersion
    Licence document URL: https://repositori.urv.cat/ca/proteccio-de-dades/
    Papper original source: Bmc Pediatrics. 23 (497):
    APA: Mas-Dalmau G; Pérez-Lacasta MJ; Alonso-Coello P; Gorrotxategi-Gorrotxategi P; Argüelles-Prendes E; Espinazo-Ramos O; Valls-Duran T; Gonzalo-Alonso ME; (2023). A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children. Bmc Pediatrics, 23(497), -. DOI: 10.1186/s12887-023-04235-3
    Entity: Universitat Rovira i Virgili
    Journal publication year: 2023
    Publication Type: Journal Publications

  • Keywords:

    Pediatrics,Pediatrics, Perinatology and Child Health
    Respiratory tract infections
    Primary care
    Paediatrics
    Delayed antibiotic prescription
    Cost effectiveness
    Saúde coletiva
    Psicología
    Planejamento urbano e regional / demografia
    Pediatrics, perinatology and child health
    Pediatrics
    Odontología
    Nutrição
    Medicina iii
    Medicina ii
    Medicina i
    Interdisciplinar
    Farmacia
    Ensino
    Engenharias ii
    Enfermagem
    Educação física
    Ciências biológicas iii
    Ciências biológicas ii
    Ciências biológicas i
    Ciências ambientais
    Ciência de alimentos
    Biotecnología

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