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van Dorst PWM, van der Pol S, Olliaro P, Dittrich S, Nkeramahame J, Postma MJ, Boersma C, van Asselt ADI. Cost-Effectiveness of Test-and-Treat Strategies to Reduce the Antibiotic Prescription Rate for Acute Febrile Illness in Primary Healthcare Clinics in Africa. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:701-715. [PMID: 38796659 PMCID: PMC11338971 DOI: 10.1007/s40258-024-00889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Inappropriate antibiotic use increases selective pressure, contributing to antimicrobial resistance. Point-of-care rapid diagnostic tests (RDTs) would be instrumental to better target antibiotic prescriptions, but widespread implementation of diagnostics for improved management of febrile illnesses is limited. OBJECTIVE Our study aims to contribute to evidence-based guidance to inform policymakers on investment decisions regarding interventions that foster more appropriate antibiotic prescriptions, as well as to address the evidence gap on the potential clinical and economic impact of RDTs on antibiotic prescription. METHODS A country-based cost-effectiveness model was developed for Burkina Faso, Ghana and Uganda. The decision tree model simulated seven test strategies for patients with febrile illness to assess the effect of different RDT combinations on antibiotic prescription rate (APR), costs and clinical outcomes. The incremental cost-effectiveness ratio (ICER) was expressed as the incremental cost per percentage point (ppt) reduction in APR. RESULTS For Burkina Faso and Uganda, testing all patients with a malaria RDT was dominant compared to standard-of-care (SoC) (which included malaria testing). Expanding the test panel with a C-reactive protein (CRP) test resulted in an ICER of $ 0.03 and $ 0.08 per ppt reduction in APR for Burkina Faso and Uganda, respectively. For Ghana, the pairwise comparison with SoC-including malaria and complete blood count testing-indicates that both testing with malaria RDT only and malaria RDT + CRP are dominant. CONCLUSION The use of RDTs for patients with febrile illness could effectively reduce APR at minimal additional costs, provided diagnostic algorithms are adhered to. Complementing SoC with CRP testing may increase clinicians' confidence in prescribing decisions and is a favourable strategy.
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Affiliation(s)
- Pim W M van Dorst
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Health-Ecore Ltd., Zeist, The Netherlands.
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Simon van der Pol
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Health-Ecore Ltd., Zeist, The Netherlands
| | - Piero Olliaro
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
| | | | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Health-Ecore Ltd., Zeist, The Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
- Department of Pharmacology and Therapy, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Cornelis Boersma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Health-Ecore Ltd., Zeist, The Netherlands
- Department of Management Sciences, Open University, Heerlen, The Netherlands
| | - Antoinette D I van Asselt
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Pai M, Gandra S, Thapa P, Carmona S. Tackling antimicrobial resistance: recognising the proposed five blind spots can accelerate progress. THE LANCET. MICROBE 2024:100968. [PMID: 39216504 DOI: 10.1016/j.lanmic.2024.100968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Madhukar Pai
- School of Population and Global Health, McGill University, Montreal, QC H3A 1G1, Canada; Manipal Academy of Higher Education, Manipal, India.
| | - Sumanth Gandra
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Poshan Thapa
- School of Population and Global Health, McGill University, Montreal, QC H3A 1G1, Canada
| | - Sergio Carmona
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Kiemde F, Nkeramahame J, Ibarz AB, Dittrich S, Olliaro P, Valia D, Rouamba T, Kabore B, Kone AN, Sawadogo S, Bere AW, Some DY, Some AM, Compaore A, Horgan P, Weber S, Keller T, Tinto H. Impact of a package of point-of-care diagnostic tests, a clinical diagnostic algorithm and adherence training on antibiotic prescriptions for the management of non-severe acute febrile illness in primary health facilities during the COVID-19 pandemic in Burkina Faso. BMC Infect Dis 2024; 24:870. [PMID: 39192209 PMCID: PMC11351252 DOI: 10.1186/s12879-024-09787-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 08/21/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE To assess the impact of an intervention package on the prescription of antibiotic and subsequently the rate of clinical recovery for non-severe acute febrile illnesses at primary health centers. METHODS Patients over 6 months of age presenting to primary health care centres with fever or history of fever within the past 7 days were randomized to receive either the intervention package constituted of point-of-care tests including COVID-19 antigen tests, a diagnostic algorithm and training and communication packages, or the standard practice. The primary outcomes were antibiotic prescriptions at Day 0 (D0) and the clinical recovery at Day 7 (D7). Secondary outcomes were non-adherence of participants and parents/caregivers to prescriptions, health workers' non-adherence to the algorithm, and the safety of the intervention. RESULTS A total of 1098 patients were enrolled. 551 (50.2%) were randomized to receive the intervention versus 547 (49.8%) received standard care. 1054 (96.0%) completed follow-up and all of them recovered at D7 in both arms. The proportion of patients with antibiotic prescriptions at D0 were 33.2% (183/551) in the intervention arm versus 58.1% (318/547) under standard care, risk difference (RD) -24.9 (95% CI -30.6 to -19.2, p < 0.001), corresponding to one more antibiotic saved every four (95% CI: 3 to 5) consultations. This reduction was also statistically significant in children from 6 to 59 months (RD -34.5; 95% CI -41.7 to -27.3; p < 0.001), patients over 18 years (RD -35.9; 95%CI -58.5 to -13.4; p = 0.002), patients with negative malaria test (RD -46.9; 95% CI -53.9 to -39.8; p < 0.001), those with a respiratory diagnosis (RD -48.9; 95% CI -56.9 to -41.0, p < 0.001) and those not vaccinated against COVID-19 (-24.8% 95%CI -30.7 to -18.9, p-value: <0.001). A significant reduction in non-adherence to prescription by patients was reported (RD -7.1; 95% CI -10.9 to -3.3; p < 0.001). CONCLUSION The intervention was associated with significant reductions of antibiotic prescriptions and non-adherence, chiefly among patients with non-malaria fever, those with respiratory symptoms and children below 5 years of age. The addition of COVID-19 testing did not have a major impact on antibiotic use at primary health centers. TRIAL REGISTRATION Clinitrial.gov; NCT04081051 registered on 06/09/2019.
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Affiliation(s)
- Francois Kiemde
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso.
| | | | | | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
| | - Piero Olliaro
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Daniel Valia
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso
| | - Berenger Kabore
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso
| | - Alima Nadine Kone
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso
| | - Seydou Sawadogo
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso
| | - Antonia Windkouni Bere
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso
| | - Diane Yirgnur Some
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso
| | - Athanase Mwinessobaonfou Some
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso
| | - Adelaide Compaore
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso
| | - Philip Horgan
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
- Evidence and Impact Oxford, Oxford, UK
| | | | | | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, 11 BP 218, Ouaga CMS 11 , Nanoro, Burkina Faso
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Nkeramahame J, Olliaro P, Horgan P, Dittrich S. Perspective on the Integration of Diagnostic Algorithms for Fever Management. Clin Infect Dis 2023; 77:S211-S213. [PMID: 37490737 PMCID: PMC10368406 DOI: 10.1093/cid/ciad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
The AMR Diagnostics Use Accelerator Program was established to address antimicrobial resistance. Here, we bring into broad perspective the findings and missed opportunities of the first phase of the program and look toward the second phase.
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Affiliation(s)
| | - Piero Olliaro
- Medical Affairs, FIND, Geneva, Switzerland
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | - Philip Horgan
- Medical Affairs, FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Department of Medicine, Evidence & Impact - Oxford, Oxford, United Kingdom
| | - Sabine Dittrich
- Medical Affairs, FIND, Geneva, Switzerland
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
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