Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka
Background Acute respiratory infections are a common reason for antibiotic overuse. We previously showed that providing Sri Lankan clinicians with positive rapid influenza test results was associated with a reduction in antibiotic prescriptions. The economic impact of influenza diagnostic strategies...
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BMJ Publishing Group
2019-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/2/e001291.full |
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| author | L Gayani Tillekeratne Champica Bodinayake Ajith Nagahawatte Ruvini Kurukulasooriya Lori A Orlando Ryan A Simmons Lawrence P Park Christopher W Woods Shelby D Reed |
| author_facet | L Gayani Tillekeratne Champica Bodinayake Ajith Nagahawatte Ruvini Kurukulasooriya Lori A Orlando Ryan A Simmons Lawrence P Park Christopher W Woods Shelby D Reed |
| author_sort | L Gayani Tillekeratne |
| collection | DOAJ |
| description | Background Acute respiratory infections are a common reason for antibiotic overuse. We previously showed that providing Sri Lankan clinicians with positive rapid influenza test results was associated with a reduction in antibiotic prescriptions. The economic impact of influenza diagnostic strategies is unknown.Methods We estimated the incremental cost per antibiotic prescription avoided with three diagnostic strategies versus standard care when managing Sri Lankan outpatients with influenza-like illness (ILI): (1) influenza clinical prediction tool, (2) targeted rapid influenza testing and (3) universal rapid influenza testing. We compared findings with literature-based estimates of the cost of antimicrobial resistance attributable to each antibiotic prescription.Results Standard care was less expensive than other strategies across all parameter values in one-way sensitivity analyses. The incremental cost per antibiotic prescription avoided with clinical prediction versus standard care was US$3.0, which was lower than the base-case estimate of the cost of antimicrobial resistance per ILI antibiotic prescription (US$12.5). The incremental cost per antibiotic prescription avoided with targeted testing and universal testing versus standard care were both higher than the base-case cost of antimicrobial resistance per ILI antibiotic prescription: US$49.1 and US$138.3, respectively. To obtain a cost-effectiveness ratio lower than US$12.5 with targeted testing versus standard care, the test price must be <US$2.6. At a higher threshold of US$28.7, the test price must be <US$7.7.Conclusion Clinical prediction tools and targeted rapid influenza testing may be cost-saving strategies in Sri Lanka when accounting for the societal cost of antimicrobial resistance. |
| format | Article |
| id | doaj-art-5dd3e073c05c4ce794400c59f68f8fab |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-5dd3e073c05c4ce794400c59f68f8fab2024-12-15T07:40:09ZengBMJ Publishing GroupBMJ Global Health2059-79082019-03-014210.1136/bmjgh-2018-001291Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri LankaL Gayani Tillekeratne0Champica Bodinayake1Ajith Nagahawatte2Ruvini Kurukulasooriya3Lori A Orlando4Ryan A Simmons5Lawrence P Park6Christopher W Woods7Shelby D Reed8Department of Medicine, University of Ruhuna Faculty of Medicine, Galle, Southern, Sri LankaFaculty of Medicine, University of Ruhuna, Galle, Sri LankaDuke Global Health Institute, Durham, North Carolina, USARuhuna-Duke Centre for Infectious Diseases, University of Ruhuna Faculty of Medicine, Galle, Southern, Sri LankaSchool of Medicine, Duke University, Durham, North Carolina, USADuke Global Health Institute, Duke University, Durham, North Carolina, USASchool of Medicine, Duke University, Durham, North Carolina, USADepartment of Medicine, Duke University School of Medicine, Durham, North Carolina, USASchool of Medicine, Duke University, Durham, North Carolina, USABackground Acute respiratory infections are a common reason for antibiotic overuse. We previously showed that providing Sri Lankan clinicians with positive rapid influenza test results was associated with a reduction in antibiotic prescriptions. The economic impact of influenza diagnostic strategies is unknown.Methods We estimated the incremental cost per antibiotic prescription avoided with three diagnostic strategies versus standard care when managing Sri Lankan outpatients with influenza-like illness (ILI): (1) influenza clinical prediction tool, (2) targeted rapid influenza testing and (3) universal rapid influenza testing. We compared findings with literature-based estimates of the cost of antimicrobial resistance attributable to each antibiotic prescription.Results Standard care was less expensive than other strategies across all parameter values in one-way sensitivity analyses. The incremental cost per antibiotic prescription avoided with clinical prediction versus standard care was US$3.0, which was lower than the base-case estimate of the cost of antimicrobial resistance per ILI antibiotic prescription (US$12.5). The incremental cost per antibiotic prescription avoided with targeted testing and universal testing versus standard care were both higher than the base-case cost of antimicrobial resistance per ILI antibiotic prescription: US$49.1 and US$138.3, respectively. To obtain a cost-effectiveness ratio lower than US$12.5 with targeted testing versus standard care, the test price must be <US$2.6. At a higher threshold of US$28.7, the test price must be <US$7.7.Conclusion Clinical prediction tools and targeted rapid influenza testing may be cost-saving strategies in Sri Lanka when accounting for the societal cost of antimicrobial resistance.https://gh.bmj.com/content/4/2/e001291.full |
| spellingShingle | L Gayani Tillekeratne Champica Bodinayake Ajith Nagahawatte Ruvini Kurukulasooriya Lori A Orlando Ryan A Simmons Lawrence P Park Christopher W Woods Shelby D Reed Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka BMJ Global Health |
| title | Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka |
| title_full | Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka |
| title_fullStr | Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka |
| title_full_unstemmed | Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka |
| title_short | Use of clinical algorithms and rapid influenza testing to manage influenza-like illness: a cost-effectiveness analysis in Sri Lanka |
| title_sort | use of clinical algorithms and rapid influenza testing to manage influenza like illness a cost effectiveness analysis in sri lanka |
| url | https://gh.bmj.com/content/4/2/e001291.full |
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