• Raymond Oppong, Mark Jit, Richard D Smith, Christopher C Butler, Hasse Melbye, Sigvard Mölstad, and Joanna Coast.
• Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham. r.a.oppong@bham.ac.uk
• Br J Gen Pract. 2013 Jul 1;63(612):e465-71.

BackgroundPoint-of-care C-reactive protein (POCCRP) is a biomarker of inflammation that offers clinicians a rapid POC test to guide antibiotic prescribing decisions for acute cough and lower respiratory tract infections (LRTI). However, evidence that POCCRP is cost-effective is limited, particularly outside experimental settings.AimTo assess the cost-effectiveness of POCCRP as a diagnostic tool for acute cough and LRTI from the perspective of the health service.Design And SettingObservational study of the presentation, management, and outcomes of patients with acute cough and LRTI in primary care settings in Norway and Sweden.MethodUsing hierarchical regression, data were analysed in terms of the effect on antibiotic use, cost, and patient outcomes (symptom severity after 7 and 14 days, time to recovery, and EQ-5D), while controlling for patient characteristics (self-reported symptom severity, comorbidities, and health-related quality of life) at first attendance.ResultsPOCCRP testing is associated with non-significant positive reductions in antibiotic prescribing (P = 0.078) and increased cost (P = 0.092). Despite the uncertainty, POCCRP testing is also associated with a cost per quality-adjusted life year (QALY) gain of €9391. At a willingness-to-pay threshold of €30,000 per QALY gained, there is a 70% probability of CRP being cost-effective.ConclusionPOCCRP testing is likely to provide a cost-effective diagnostic intervention both in terms of reducing antibiotic prescribing and in terms of QALYs gained.

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