In 2021/2022 approximately 75% of the 1,140,000 Acute Respiratory Infections (ARI) attendances to emergency department (ED) attendances were not admitted. Indicating that a large proportion could have been managed in the community. 1
In Autumn 2022, NHS England supported and funded the setting up of 363 ARI Hubs around England. These ARI Hubs provided 729,808 appointments between December 2022 and March 2023 and so prevented the same number of hospital attendances.
In a 2020 article published in the Journal of Medical Economics by John Schneider et al2, Acute Respiratory Infections (ARI) accounts for over two-thirds of total antibiotic prescriptions, even though most were caused by viruses that do not benefit from antibiotics.
Most antibiotics are prescribed in the outpatients setting.
Antibiotic overuse leads to antibiotic-related adverse events (AEs), inclusive of secondary infections, resistance, and increased costs.
Therefore Point-of-Care tests (POCT) may reduce unnecessary prescribing of antibiotics.
A cost analysis was performed to assess diagnostic POCT options to identify patients with an ARI that may benefit from antibiotics in a UK out-patient setting.
Using NICE data and direct costs (antibiotics, AEs, POCTs) derived from published literature. Otitis media, sinusitis, pharyngitis and bronchitis were considered the most common ARIs.
Antibiotic-related AE costs were calculated using re-consultation costs for anaphylaxis, Stevens-Johnson syndrome, allergies/diarrhoea/nausea, C. difficile infection (CDI).
Potential cost-savings from POCTs were assessed by evaluating NICE guideline-referenced POCTs (CRP, Febri Dx, Sarasota, FL) as well as a target product profile (TPP).
Results Shockingly 55% (7,718,283) of ARI consultations resulted in antibiotics whilst guideline-based prescribing suggested appropriate antibiotic prescriptions were only warranted for 9% (1,444,877) of these ARI consultations.
Direct antibiotic costs for actual ARI consultations associated with antibiotics was £24,003,866 vs.£4,493,568 for guideline-based, “appropriate” antibiotic prescriptions.
Antibiotic-related AEs and re-consultations for actual vs. appropriate prescribing totalled £302,496,486 vs. £63,854,269.
ARI prescribing plus AE costs totalled £326,729,943 annually without the use of delayed prescribing practices or POCT while the addition of delayed prescribing plus POCT totalled £60,114,564–£78,148,933 depending on the POCT.
Conclusions Adding POCT to outpatient triage of ARI can reduce unnecessary antibiotics and anti-biotic-related AEs, resulting in substantial cost savings. Further, near patient diagnostic testing can benefit health systems and patients by avoiding exposure to unnecessary drugs, side effects and anti-biotic resistant pathogens.