Assessing the Clinical and Economic Benefits of Implementing Point-of-care C-Reactive Protein Test to Manage Respiratory Tract Infections: Insights From Clinician Interviews in Four European Countries

Abstract

Abstract Background Antimicrobial resistance (AMR) is a critical challenge for public health, driven by the overuse of antibiotics. Testing for C-reactive protein (CRP) using point-of-care (POC) tests is recommended in many European guidelines, but the uptake and availability of POC CRP tests vary widely. This study aims to describe patient pathways for respiratory tract infections (RTIs) in primary care across four European countries: Norway and the Netherlands, where POC CRP testing is used in routine care, and England and Italy, where such testing is not used; and to evaluate the potential impact of introducing POC CRP testing in the latter. Methods Interviews were conducted with eight general practitioners (GPs) across four countries. The GPs in Norway and the Netherlands used POC CRP tests, the GPs in England and Italy did not. Current care pathways were mapped for all eight clinics, and hypothetical POC CRP pathways were mapped for clinics in England and Italy. Cost and resource-use data were collated from clinician interviews and published evidence to estimate total resources and costs per pathway. Antibiotic prescriptions, hospital referrals, and pathway costs were compared between current and hypothetical pathways (England and Italy). Results In Norway and the Netherlands, estimated antibiotic prescriptions per 100 patients were 0.3–21.6, hospital referrals per 100 patients were 0.0–1.6, and mean costs per patient were €15.64 - €52.07. In England and Italy, antibiotic prescriptions per 100 patients were 22.0–68.4, hospital referrals per 100 patients were 0.6–11.6, and mean pathway costs per patient were £23.01 - £49.63 (England) and €24.28 - €50.82 (Italy). In hypothetical POC CRP testing pathways, potential reductions in healthcare utilisation were estimated (antibiotic prescriptions 28%, hospital referrals 35%, and pathway costs 24%). Conclusions Implementation of POC CRP testing for patients with RTI in primary care could help reduce unnecessary antibiotic prescriptions, hospital referrals and total pathway costs.