Budget Impact Analysis of Implementing C-Reactive Protein Point-of-Care Testing to Aid Antibiotic Prescribing in...

The inappropriate use of antibiotics is a key driver of antimicrobial resistance (AMR) and can lead to various adverse side effects. C-reactive protein (CRP) point-of-care testing (POCT) in primary care has shown potential as an effective strategy to reduce inappropriate antibiotic prescribing. This study evaluates the budget impact of introducing CRP POCT in Belgian primary care over a 5-year time horizon.

A decision tree model was developed to compare the budget impact of implementing CRP POCT in primary care versus usual care (without CRP POCT) based on 712,102 acute cough patients annually. Cost and probability parameters were derived through literature review and primary data collection. The robustness of the findings was assessed using univariate and probabilistic sensitivity analyses. Additionally, alternative scenarios were explored by modifying key assumptions in the base-case scenario to evaluate the effect on the results.

Over a 5-year period, implementing CRP POCT in Belgian primary care for the management of 712,102 acute cough patients annually is estimated to result in an incremental cost of approximately €12.8 million (95% credible interval: 12,699,459 to 12,924,898), primarily driven by capital expenditures for analysers and CRP test expenses. Scenario analyses showed substantial variation in budget impact depending on implementation choices, ranging from €13.6 million to €39.6 million, with the highest costs when general practitioners' (GPs') compensation was included. Reduced inappropriate antibiotic use, adverse side effects, and AMR rates would decrease costs, with these savings expected to grow over time as CRP POCT becomes more widely adopted. However, the proportion of these savings relative to total expenditure is limited.

The implementation of CRP POCT entails a significant financial investment. Our scenario analyses indicate a substantial increase in budget impact when GPs' compensation was included. However, a well-designed implementation strategy with an appropriate GP compensation structure may be crucial to avoid inefficiencies from over- or underuse of CRP testing and achieve the anticipated health benefits.