Application of a simple point-of-care test to reduce UK healthcare costs and adverse events in outpatient acute respiratory infections

Figures & data

Table 1. Consultations resulting in antibiotic prescription: actual vs. appropriate prescribing assumptions calculated from published data (2014, 2018), combined for all age groups.

ARI conditions	Proportion of annual ARI consultations [Guilliford 2014]	Number of annual ARI consultations (proportion per condition × total ARI visits)	Proportion of ARI consultations receiving antibiotics (actual) [Pouwels 2018]	Number of annual ARI consultations receiving antibiotics (actual)	Proportion of ARI consultations receiving antibiotics (appropriate) [Pouwels 2018]	Number of ARI consultations receiving antibiotics (appropriate) [Pouwels 2018]	Number of ARI consultations receiving excess antibiotics (actual-appropriate)
Non-specified URI (common cold, laryngitis tracheitis and flu-like illness)	0.19	2,914,296	0.25	728,574	0	0	728,574
Acute otitis media (age 0 − 18 years)	0.06	920,304	0.89	819,071	0.17	156,451	662,618
Acute rhinosinusitis	0.09	1,380,456	0.88	1,214,801	0.11	151,850	1,062,951
Acute pharyngitis/sore throat/tonsillitis	0.27	4,141,368	0.59	2,443,407	0.13	538,377	1,905,029
Acute bronchitis/Cough	0.39	5,981,976	0.42	2,512,430	0.1	598,197	1,914,232
Total		15,338,400		7,718,283		1,444,877	6,273,406

Table 2. Antibiotic cost of treatment for each ARI condition.

Condition	Antibiotic	% Utilization	Price (£)/5–10 day course	References
Acute bronchitis/acute cough	Amoxicillin	79.0	1.12	Excellence NIFHaC^38
	Other (cefaclor, azithromycin, cefalexin, trimethoprim, flucloxacillin)	4.5	1.62
	Erythromycin	7.9	0.91
	Co-amoxiclav	2.9	1.37
	Clarithromycin	4.8	0.86
	Doxycycline	0.9	0.44
Otitis media	Amoxicillin	80.3	1.34	Excellence NIoHaC^39
	Other (cefaclor, doxycycline, azithromycin, cefalexin, trimethoprim, flucloxacillin)	4.0	1.73
	Erythromycin	7.5	1.09
	Co-amoxiclav	4.5	1.64
	Penicillin-V	1.2	1.44
	Clarithromycin	2.5	1.03
Acute rhinosinusitis Acute sore throat Non-specified URI^a (common cold, laryngitis and tracheitis, Flu-like Illness)^a	Penicillin -V	56.0	1.20	Excellence NIFHaC^38
	Amoxicillin	26.8	1.12
	Other (cefaclor, doxycycline, azithromycin, cefalexin, trimethoprim, flucloxacillin)	4.5	1.44
	Erythromycin	8.4	0.91
	Co-amoxiclav	1.5	1.37
	Clarithromycin	2.8	0.86

^a Antibiotics are not indicated for non-specified URI.

Table 3. Assumptions for the cost and accuracy of diagnostic tests.

POCT	Sensitivity (%) (median)	Specificity (%) (median)	Accuracy (%)	Cost (GBP)	References
Biomarker triage (TPP)	90–95	80–90	88	1 − 5^a	Dittrich et al.^26
C-reactive protein (CRP)	64–95 (86)	49–76 (69)	80^b	13.5^c	Simon et al.^50
Multiplex (FebriDx)	95	94	92	11.25	Shapiro et al.^29

Abbreviations. TPP, Target product profile; AUC, Area under the curve; POCT, Point-of-care-test.

^a Costs in the original publication were estimated in US dollars and for illustration purposes converted using a 1:1 conversion factor.

^b The accuracy value was averaged from a recent systematic review which found a sensitivity range of 0.59–95 in febrile populations.

^c Inclusive of analyzer reagent costs as per NICE 2017.

Figure 1. Budget impact analysis.

Table 4. Estimated total costs for ARI Consultation (2018) with and without POCT.

Total annual cost to health system without POCT (AB + AE)	Total annual cost to health system with CRP (POCT + AB + AE)	Total annual cost to health system with TPP (POCT + AB + AE)	Total annual cost to health system with FebriDx (POCT + AB + AE)
£32,65,00,346	£29,02,95,065	£14,78,05,881	£23,76,14,489

Table 5. Estimated annual cost for ARI consultation (2018) savings with POCT.

Without POCT-CRP	Without POCT-TPP	Without POCT-FebriDx
£3,62,05,281	£17,86,94,465	£8,88,85,857

Table 6. Sensitivity analysis.

	Variable impacted			Impact on total cost
	CRP	FebriDx	TPP	CRP	FebriDx	TPP
Cost of the POCT
Base cost	£13.50	£11.25	£5.00	£29,02,95,065	£23,76,14,489	£14,78,05,881
Test cost + 20%	£16.20	£13.50	£6.00	£33,17,08,745	£27,21,25,889	£16,31,44,281
Test cost – 20%	£10.80	£9.00	£4.00	£24,88,81,385	£20,31,03,089	£13,24,67,481
Target population (ARI) tested
Base target population	15,338,400	15,338,400	15,338,400	£29,02,95,065	£23,76,14,489	£14,78,05,881
Target population + 25%	19,173,000	19,173,000	19,173,000	£34,20,62,165	£28,07,53,739	£16,69,78,881
Target population – 25%	11,503,800	11,503,800	11,503,800	£23,85,27,965	£19,48,70,673	£12,86,32,881
Antibiotic related AEs
Base antibiotic related AEs	116,449	89,576	98,534	£29,02,95,065	£23,76,14,489	£14,78,05,881
Antibiotic related AEs + 25%	145,561	111,970	123,167	£30,98,32,298	£25,26,43,130	£16,43,37,386
Antibiotic related AEs − 25%	86,440	67,182	73,900	£26,17,84,868	£22,25,85,848	£13,12,74,376
Average antibiotic prescriptions/cost
Base antibiotic prescriptions	1,993,992	1,533,840	1,687,224
Antibiotic prescriptions + 25%	2,492,490	1,917,300	2,109,030
Antibiotic prescriptions − 25%	1,495,494	1,150,380	1,265,418
Base antibiotic costs	£50,77,732	£49,42,925	£49,87,860	£29,02,95,065	£23,76,14,489	£14,78,05,881
Antibiotic costs + 25%	£55,76,230	£53,26,385	£54,09,666	£29,07,93,563	£23,79,97,949	£14,82,27,687
Antibiotic costs – 25%	£45,79,234	£45,59,465	£45,66,054	£28,97,96,567	£23,72,31,029	£14,73,84,075

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