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Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance

Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance
Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance
Background: Lower respiratory tract infections (LRTIs) are a major disease burden and are often treated with antibiotics. Typically, studies evaluating the use of antibiotics focus on immediate costs of care, and do not account for the wider implications of antimicrobial resistance.

Aim: This study sought to establish whether antibiotics (principally amoxicillin) are cost effective in patients with LRTIs, and to explore the implications of taking into account costs associated with resistance.

Design and setting: Multinational randomised double-blinded trial in 2060 patients with acute cough/LRTIs recruited in 12 European countries.

Method: A cost-utility analysis from a health system perspective with a time horizon of 28 days was conducted. The primary outcome measure was the quality-adjusted life year (QALY). Hierarchical modelling was used to estimate incremental cost-effectiveness ratios (ICERs).

Results: Amoxicillin was associated with an ICER of €8216 (£6540) per QALY gained when the cost of resistance was excluded. If the cost of resistance is greater than €11 (£9) per patient, then amoxicillin treatment is no longer cost effective. Including possible estimates of the cost of resistance resulted in ICERs ranging from €14 730 (£11 949) per QALY gained — when only multidrug resistance costs and health care costs are included — to €727 135 (£589 856) per QALY gained when broader societal costs are also included.

Conclusion: Economic evaluation of antibiotic prescribing strategies that do not include the cost of resistance may provide misleading results that could be of questionable use to policymakers. However, further work is required to estimate robust costs of resistance.
0960-1643
1-25
Oppong, Raymond
fe6a54b3-9bdb-4117-9697-a19935d92a2d
Smith, Richard D.
3d8223af-9e0a-43c6-ba61-1a693a5f4014
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Coast, Joanna
062a356d-95a4-46f0-af55-6f1438e8cd4d
Oppong, Raymond
fe6a54b3-9bdb-4117-9697-a19935d92a2d
Smith, Richard D.
3d8223af-9e0a-43c6-ba61-1a693a5f4014
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Coast, Joanna
062a356d-95a4-46f0-af55-6f1438e8cd4d

Oppong, Raymond, Smith, Richard D., Little, Paul, Verheij, Theo, Butler, Christopher C., Goossens, Herman, Coenen, Samuel, Moore, Michael and Coast, Joanna (2016) Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance. British Journal of General Practice, 1-25. (doi:10.3399/bjgp16X686533). (PMID:27402969)

Record type: Article

Abstract

Background: Lower respiratory tract infections (LRTIs) are a major disease burden and are often treated with antibiotics. Typically, studies evaluating the use of antibiotics focus on immediate costs of care, and do not account for the wider implications of antimicrobial resistance.

Aim: This study sought to establish whether antibiotics (principally amoxicillin) are cost effective in patients with LRTIs, and to explore the implications of taking into account costs associated with resistance.

Design and setting: Multinational randomised double-blinded trial in 2060 patients with acute cough/LRTIs recruited in 12 European countries.

Method: A cost-utility analysis from a health system perspective with a time horizon of 28 days was conducted. The primary outcome measure was the quality-adjusted life year (QALY). Hierarchical modelling was used to estimate incremental cost-effectiveness ratios (ICERs).

Results: Amoxicillin was associated with an ICER of €8216 (£6540) per QALY gained when the cost of resistance was excluded. If the cost of resistance is greater than €11 (£9) per patient, then amoxicillin treatment is no longer cost effective. Including possible estimates of the cost of resistance resulted in ICERs ranging from €14 730 (£11 949) per QALY gained — when only multidrug resistance costs and health care costs are included — to €727 135 (£589 856) per QALY gained when broader societal costs are also included.

Conclusion: Economic evaluation of antibiotic prescribing strategies that do not include the cost of resistance may provide misleading results that could be of questionable use to policymakers. However, further work is required to estimate robust costs of resistance.

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Accepted/In Press date: 6 April 2016
e-pub ahead of print date: 21 June 2016
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 391388
URI: https://eprints.soton.ac.uk/id/eprint/391388
ISSN: 0960-1643
PURE UUID: f4e856da-bb3a-46fb-838d-e11d2a2e72a7
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 12 Apr 2016 09:38
Last modified: 15 Oct 2019 00:44

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