Cost-effectiveness of CRP POCT for respiratory diagnosis in low-resource setting: As Kyrgyz pediatric practice

Background: Patients with respiratory tract infections (RTIs) are often prescribed antibiotics in primary healthcare (PHC). However, there is little evidence that antibiotics are of benefit in the treatment of most RTIs. C-reactive protein (CRP) point-of-care testing (POCT) can reduce the need for antibiotics, thereby reducing healthcare costs. Objective: We aimed to estimate the national clinical and economic burden of RTI and determine the cost-effectiveness of CRP POCT for children under 12 with acute respiratory symptoms in PHC in Kyrgyzstan. Methods: An economic evaluation alongside a randomized controlled clinical trial with 14 days of blinded follow-up in 14 rural villages of Kyrgyzstan was conducted on children aged from 6 months to 12 years attending the PHC centers with acute respiratory symptoms. Structured questionnaires (healthcare utilization, EQ-5D-Y, WPAI) were used to determine the clinical and economic burden. The primary outcome was the incremental cost-effectiveness ratio (ICER). Results: From 1204 participants’ boys were 51.9% (625), and girls 48.1% (579). The mean age was 24 months in usual care group and 52 months in intervention group. The number of avoided antibiotic (AB) prescriptions in CRP group and control group were 71,9% (432) and 51.1% (307) respectively. The mean costs of AB were $2 and $1.4 in the control and CRP groups respectively. The average annual cost for antimicrobial treatment in respiratory diseases was $673564, while with intervention it would be $471495, which will reduce costs for AB by 1,5 times. Conclusions: The results showed that CRP POCT increased differentiation between viral and bacterial infections and reduced unnecessary antibiotic prescriptions, thereby reducing antimicrobial costs by one and a half times. Thus, improving primary care management through supplying alternative supportive medication for those not in need of antibiotics, potentially enhancing the cost-effectiveness of care. Keywords: children, antibiotics, health economics, cost-effectiveness, C-reactive protein (CRP), respiratory tract infections.