經濟評估顯示:C反應蛋白測試與醫生溝通技巧培訓有效降低抗生素處方

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一項對下呼吸道感染(LRTI)治療的經濟評估研究發現,醫生使用C反應蛋白(CRP)現場測試與溝通技巧培訓,無論單獨或結合使用,都是降低抗生素處方的成本效益高的干預措施。研究包括431名LRTI患者,結果顯示,使用CRP測試和溝通技巧培訓的組合,抗生素處方率降至23%,在低或無願意支付額度下均具有成本效益。

C反應蛋白即時診療測試和醫師溝通技巧培訓在一般實踐中對於下呼吸道感染的經濟評估:一項群體隨機試驗的經濟評估

C-reactive protein point of care testing and physician communication skills training for lower respiratory tract infections in general practice: economic evaluation of a cluster randomized trial

Cals JW, Ament AJ, Hood K, Butler CC, Hopstaken RM, Wassink GF, Dinant GJ. C-reactive protein point of care testing and physician communication skills training for lower respiratory tract infections in general practice: economic evaluation of a cluster randomized trial. J Eval Clin Pract. 2011 Dec;17(6):1059-69. doi: 10.1111/j.1365-2753.2010.01472.x. Epub 2010 Jul 8. PMID: 20666881.

https://pubmed.ncbi.nlm.nih.gov/20666881/

Abstract

Rationale, aims and objectives

An economic evaluation of general practitioner (GP) use of C-reactive protein (CRP) point of care test, GP communication skills training, and both GP use of CRP and communication skills training on antibiotic use for lower respiratory tract infections (LRTIs) in general practice.

Methods

Cost-effectiveness analysis with a time horizon of 28 days alongside a factorial, cluster randomized trial in 431 patients with LRTIs recruited by 40 GPs.

Interventions

usual care (control group), GP use of CRP point of care test, GP communication skills training, and both CRP use and communication skills training.

Main outcome measure

health care costs. Cost-effectiveness, using the primary outcome measure antibiotic prescribing at index consultation, was assessed by incremental cost-effectiveness ratios (ICER). To adjust for skewed data and clustering, we used non-parametric bootstrapping re-sampling to derive percentile intervals for the mean difference in total costs and the mean difference in effectiveness between the groups. Various implementation scenarios according to GP preference were modelled with corresponding net monetary benefit (NMB) curves based on a given willingness-to-pay (λ) for a 1% lower antibiotic prescribing rate.

Results

The total mean cost per patient in the usual care group was €35.96 with antibiotic prescribing of 68%, €37.58 per patient managed by GPs using CRP tests (antibiotic prescribing 39%, ICER €5.79), €25.61 per patient managed by GPs trained in enhanced communication skills (antibiotic prescribing 33%, dominant) and €37.78 per patient managed by GPs using both interventions (antibiotic prescribing 23%, ICER €4.15). The interventions are cost-effective in any combination (yielding NMB at no willingness-to-pay), taking into account GPs’ preferences where at least 15% of GPs chose to implement the communication skills training.

Conclusions

The two strategies, both singly and combined, are cost-effective interventions to reduce antibiotic prescribing for LRTI, at no, or low willingness-to-pay. Taking GP preferences into account will optimize investment in strategies to reduce antibiotic prescribing for LRTI.

摘要

理由、目標與目的

對一般執業醫師(GP)使用C反應蛋白(CRP)即時診療測試、GP溝通技巧培訓,以及GP同時使用CRP和溝通技巧培訓對於一般實踐中下呼吸道感染(LRTI)抗生素使用的經濟評估。

方法

在431名由40位GP招募的LRTI患者中進行的一項因素、群體隨機試驗中,進行了28天時限的成本效益分析。

干預措施

通常護理(對照組)、GP使用CRP即時診療測試、GP溝通技巧培訓,以及CRP使用和溝通技巧培訓兩者。

主要結果指標

醫療保健成本。使用主要結果指標在首次諮詢時的抗生素處方進行成本效益評估,通過增量成本效果比(ICER)進行評估。為了調整數據的偏斜和聚集性,我們使用非參數自助重抽樣來獲得各組之間總成本的平均差異和有效性的平均差異的百分位區間。根據GP的偏好,模擬了各種實施方案,並根據對1%較低的抗生素處方率的支付意願(λ)繪製了相應的凈貨幣效益(NMB)曲線。

結果:通常護理

組每位患者的總平均成本為35.96歐元,抗生素處方率為68%,由使用CRP測試的GP管理的患者每位37.58歐元(抗生素處方率39%,ICER為5.79歐元),接受增強溝通技巧培訓的GP管理的患者每位25.61歐元(抗生素處方率33%,佔主導地位),以及由使用兩種干預措施的GP管理的患者每位37.78歐元(抗生素處方率23%,ICER為4.15歐元)。在任何組合中,這些干預措施都是具成本效益的(即使在無支付意願的情況下也能產生NMB),考慮到至少有15%的GP選擇實施溝通技巧培訓。

結論

這兩種策略,單獨或結合使用,都是在無或低支付意願的情況下減少LRTI抗生素處方的具成本效益的干預措施。考慮到GP的偏好將優化投資於減少LRTI抗生素處方的策略。