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1. A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children

Author

Universitat Rovira i Virgili, Mas-Dalmau G; Pérez-Lacasta MJ; Alonso-Coello P; Gorrotxategi-Gorrotxategi P; Argüelles-Prendes E; Espinazo-Ramos O; Valls-Duran T; Gonzalo-Alonso ME; Cortés-Viana MP; Menéndez-Bada T; Vázquez-Fernández ME; Pérez-Hernández AI; Muñoz-Ortiz L; Villanueva-López C; Little P; de la Poza-Abad M; Carles-Lavila M; DAP Paediatrics Group, Universitat Rovira i Virgili, and Mas-Dalmau G; Pérez-Lacasta MJ; Alonso-Coello P; Gorrotxategi-Gorrotxategi P; Argüelles-Prendes E; Espinazo-Ramos O; Valls-Duran T; Gonzalo-Alonso ME; Cortés-Viana MP; Menéndez-Bada T; Vázquez-Fernández ME; Pérez-Hernández AI; Muñoz-Ortiz L; Villanueva-López C; Little P; de la Poza-Abad M; Carles-Lavila M; DAP Paediatrics Group

Abstract

Antibiotic prescription for respiratory tract infections (RTIs) in children attending primary care centres is almost double that predicted according to bacterial prevalence. Delayed antibiotic prescription (DAP) is designed to deploy a more rational use of antibiotics. While studies have evaluated DAP efficacy and safety for children with RTIs, little research has been conducted on the economic implications.Our trial compared cost-effectiveness for DAP, immediate antibiotic prescription (IAP), and no antibiotic prescription (NAP) for children aged 2-14 years with acute uncomplicated RTIs attended to in 39 primary care centres in Spain. The main outcome was the incremental cost-effectiveness ratio (ICER), measured in euros per gained quality-adjusted life days (QALDs). Net monetary benefit (NMB) was also calculated as a tool for decision making. The analysis was performed from a societal perspective for a time horizon of 30 days, and included healthcare direct costs, non-healthcare direct and indirect costs, and the antimicrobial resistance (AMR) cost.DAP was the most cost-effective strategy, even when the cost of AMR was included. QALD values for the three strategies were very similar. IAP compared to DAP was more costly (109.68 vs 100.90 euros) and similarly effective (27.88 vs 27.94 QALDs). DAP compared to NAP was more costly (100.90 vs 97.48 euros) and more effective (27.94 vs. 27.82 QALDs). The ICER for DAP compared to NAP was 28.84 euros per QALD. The deterministic sensitivity analysis indicated that non-healthcare indirect costs had the greatest impact on the ICER. The cost-effectiveness acceptability curve showed that DAP was the preferred option in approximately 81.75% of Monte Carlo iterations, assuming a willingness-to-pay value of 82.2 euros per gained QALD.W

Published
2023

2. Epidemiological and clinical characteristics and the approach to infant chickenpox in primary care

Author

Rodriguez-Santana Y, Sanchez-Almeida E, Garcia-Vera C, Garcia-Ventura M, Martinez-Espligares L, Abad-Balaguer B, Acitores-Suz E, Aguilera-Lopez L, Aizpurua-Galdeano M, Albaladejo-Beltran S, Alcaraz-Quinonero M, Alonso-Bernardo L, Alvarez-Bueno E, de Laviada-Mulero T, Aparicio-Rodrigo M, Canedo-Arguelles C, Arnal-Alonso J, Arranz-Sanjuan R, Arroyo-Ubeda R, Asensi-Monzo M, Astiz-Blanco M, Ayechu-Diaz A, Balaguer-Martinez J, Barea-Garcia J, Barral-Mena E, Barrios-Gonzalez E, Batalla-Fado L, Bayona-Ferrer I, Bejarano-Lopez M, Belda-Garcia M, Benitez-Rubio M, Bercedo-Sanz A, Bernabe-Moyano M, Bernad-Usoz J, Biosca-Pamies M, Blanco-Gonzalez J, Blesa-Baviera L, Bombin-Granado J, Bonet-Garrosa A, del Arco I, Botella-Serrano B, Boullosa M, Bravo-Acuna J, Breton-Pena A, Burgaleta-Sagaseta A, Caballero-Morales M, Cairo-Corominas S, Calavia-Moreno C, Callejas-Pozo J, Calvo-Lorenzo M, Canadell-Villaret D, Cantarero-Vallejo M, Capell-Redondo G, Carballal-Marino M, Carmona-Cedres N, Caro-Gomez A, Carrera-Polanco M, Carretero L, Casado-Sanchez M, Casares-Alonso I, Cascon-Criado E, de-Asprer A, Casquet-Barcelo A, Caubet-Busquet I, Cayuela-Guerrero C, del-Olmo Y, Chinarro-Martinez P, Coello-Torres Z, Coto-Fuente M, Gallego E, Garcia M, Romero D, Diaz-Varela C, Aguas G, Calero C, Diaz-Cirujano A, Diaz-Sanchez A, Diaz-Zaera O, Dominguez-Aurrecoechea B, Duelo-Marcos M, Elorza-Beitia C, Escanciano-Garcia Y, Escribano-Romero M, Esparza-Olcina M, Espin-Quirante C, Espinazo-Ramos O, Esquivel-Ojeda J, Fabregat-Ferrer E, Fernandez-Leon A, Fernandez-Pastor F, Fernandez-Cuesta-Valcarce M, Ferrandiz-Cerda B, Flores-Erro U, Fontalva-Ballesteros M, Galan-Rico J, Galardi-Andonegui M, Gallego-Iborra A, Garach-Gomez A, Garces-Sanchez M, Garcia-Merida M, Garcia-Perez R, Garcia-Rebollar C, Garcia-Rodriguez A, Garcia-Santiago M, Garcia-Onieva-Artazcoz M, Garcia E, Garrido-Redondo M, Gil-Alexandres I, Gil-Camarero E, San Andres M, Giribet-Folch M, Gomez-Maraver M, Gomez-Sorrigueta P, Gonzalez-Cortes M, Gonzalez-Herrero M, Gonzalez-Rodriguez M, Gonzalez-Valdes S, Gracia-Alfonso M, Grau-Garcia A, Gros-Esteban D, Guillot-Rosello B, Gutierrez-Abad C, Gutierrez-Blasco J, Gutierrez-Sigler M, Heras-Galindo J, Hernandez-Encinas M, Hernandez-Guillen R, Hernandez-Ortiz M, Hernando-Helguero P, Hernando-Zarate Z, De Arce A, Iribarren-Udobro I, Iturrioz-Mata A, Jaldo-Jimenez M, Jaramillo-Hidalgo D, Jimenez-Ales R, Jimenez-Hereza J, Jove-Naval J, de Toledo B, Julia-Benito J, Labordena-Barcelo C, Laso-Murillo P, Ledesma-Albarran J, Lobelle-Gonzalez C, Lobera-Navaz P, Lopez-Alonso R, Lorente-Garcia S, Lorente-Garcia-Maurino A, Losa-Frias V, Lupiani-Castellanos P, Marco-Puche A, Marfil-Olink S, Marquez-Moreno M, Martin-Carballo G, Martin-Delgado M, Martin L, Martin-Rial S, Martinez-Moral N, Martinez-Rubio M, Martinez-Rubio A, Martos-Lozano C, Mendez-Gallego S, Menendez-Bada T, Menendez-Gonzalez N, Mengual-Gil J, Minguez-Verdejo R, Miranda-Berrioategortua I, Moneo-Hernandez I, Montanes-Sanchez A, Montes-Pena M, Munoz-Hiraldo M, Murcia-Garcia J, Mustieles-Moreno C, Navarro-Cabanas G, Navarro-Quesada F, Navas-Heredia C, Novo-Rodriguez A, Nuno-Martin F, Ordonez-Alonso A, Ortells-Ramon I, Padilla-Esteban M, Padilla-Sanchez M, Palomares-Gimeno M, Palomino-Urda N, Panizo-Santos M, Parejo-Carranza R, Pavo-Garcia M, Peix-Sambola M, Pena-Nieto M, Penarroja-Peirats S, Perez-Candas J, Taramona M, Perez-Garcia I, Perez-Gavilan J, Perez-Serrano M, Perez-Tomas R, Perez-Vidal M, Pinilla-Fuentes J, Polo-Mellado M, Prado-Munoz S, Pulido-Bosch M, Pumarola-Batlle M, Quintanilla-Sanchez M, Ramirez-Gavira R, Ramos-Zugasti M, del Castillo C, Ribera-Sirvent C, Rico-Mari E, Ripoll-Lozano A, Rivas-Abraldes N, Riveros-Huckstadt M, Robles-Garcia J, Rodriguez-Delgado J, Rodriguez-Fernandez M, Rodriguez-Fernandez-Oliva C, Rodriguez-Lombardia C, Rodriguez-Mur P, Rodriguez-Varela A, Rodriguez-Lopez-Marquez G, Rodriguez-Moldes-Vazquez B, Rodriguez-Salinas-Perez E, Romero-Reyes C, Ruiz-Chercoles E, Ruiz-Sanchez J, Ruiz-Canela-Caceres J, Ruiz-Cuevas-Garcias P, de Urturi-Sanchez A, De Lafuente-Arriazu A, Salva-Siquier A, Sanantonio-Valdearcos F, Sanchez-Andrada R, Sanchez-Calderon M, Sanchez-Cordero N, Sanchez-Diaz M, Sanchez-Echenique M, Sanchez-Fuentes V, Monge M, Sanchez-Gonzalez B, Sanchez-Jimenez M, Sanchez-Pina C, Sanchez-Precioso S, Sancho-Madrid B, Satrustegui-Gamboa F, Segovia-Ferrera C, Seijas-Vazquez L, Serna-Saugar M, Serrano-Gomez M, Servera-Ginard C, Somoza-Martin M, Soriano-Faura J, Suarez-Vicent E, Surribas-Murillo C, de Arcaya M, Ubeda-Sansano I, Valdivia-Jimenez C, Valls-Duran T, Vaquerizo-Pollino M, Vega-Perez M, Velasco-Guijarro O, Vera-Dominguez M, Viar-Urieta M, Vigueras-Abellan J, Vila-Alonso M, Vila-Buch G, Vilchez-Perez J, Villafruela-Alvarez C, Villaizan-Perez C, Villar-Fernandez M, de Velasco A, Viver-Gomez S, and PAPenRED

Published
2019

3. A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.

Author

Mas-Dalmau G, Pérez-Lacasta MJ, Alonso-Coello P, Gorrotxategi-Gorrotxategi P, Argüelles-Prendes E, Espinazo-Ramos O, Valls-Duran T, Gonzalo-Alonso ME, Cortés-Viana MP, Menéndez-Bada T, Vázquez-Fernández ME, Pérez-Hernández AI, Muñoz-Ortiz L, Villanueva-López C, Little P, de la Poza-Abad M, and Carles-Lavila M

Subjects
Humans, Child, Cost-Effectiveness Analysis, Spain, Prescriptions, Cost-Benefit Analysis, Anti-Bacterial Agents therapeutic use, Respiratory Tract Infections drug therapy
Abstract

Background: Antibiotic prescription for respiratory tract infections (RTIs) in children attending primary care centres is almost double that predicted according to bacterial prevalence. Delayed antibiotic prescription (DAP) is designed to deploy a more rational use of antibiotics. While studies have evaluated DAP efficacy and safety for children with RTIs, little research has been conducted on the economic implications., Methods: Our trial compared cost-effectiveness for DAP, immediate antibiotic prescription (IAP), and no antibiotic prescription (NAP) for children aged 2-14 years with acute uncomplicated RTIs attended to in 39 primary care centres in Spain. The main outcome was the incremental cost-effectiveness ratio (ICER), measured in euros per gained quality-adjusted life days (QALDs). Net monetary benefit (NMB) was also calculated as a tool for decision making. The analysis was performed from a societal perspective for a time horizon of 30 days, and included healthcare direct costs, non-healthcare direct and indirect costs, and the antimicrobial resistance (AMR) cost., Results: DAP was the most cost-effective strategy, even when the cost of AMR was included. QALD values for the three strategies were very similar. IAP compared to DAP was more costly (109.68 vs 100.90 euros) and similarly effective (27.88 vs 27.94 QALDs). DAP compared to NAP was more costly (100.90 vs 97.48 euros) and more effective (27.94 vs. 27.82 QALDs). The ICER for DAP compared to NAP was 28.84 euros per QALD. The deterministic sensitivity analysis indicated that non-healthcare indirect costs had the greatest impact on the ICER. The cost-effectiveness acceptability curve showed that DAP was the preferred option in approximately 81.75% of Monte Carlo iterations, assuming a willingness-to-pay value of 82.2 euros per gained QALD., Conclusions: When clinicians are in doubt about whether an antibiotic is needed for children with RTIs attending PC centres, those treated with the DAP strategy will have slightly better efficiency outcomes than those treated with IAP because its costs are lower than those of IAP. DAP is also the most cost-effective strategy over a time horizon of 30 days if AMR is considered, despite higher short-term costs than NAP. However, if in the long term the costs of AMR are larger than estimated, NAP could also be an alternative strategy., Trial Registration: This trial has been registered at www., Clinicaltrials: gov (identifier NCT01800747; Date: 28/02/2013 (retrospectively registered)., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Published
2023
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4. Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial.

Author

Mas-Dalmau G, Villanueva López C, Gorrotxategi Gorrotxategi P, Argüelles Prendes E, Espinazo Ramos O, Valls Duran T, Gonzalo Alonso ME, Cortés Viana MP, Menéndez Bada T, Vázquez Fernández ME, Pérez Hernández AI, Muñoz Ortiz L, Little P, de la Poza Abad M, and Alonso-Coello P

Subjects
Adolescent, Anti-Bacterial Agents adverse effects, Child, Child, Preschool, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Parents psychology, Patient Satisfaction, Primary Health Care, Respiratory Tract Infections complications, Severity of Illness Index, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Respiratory Tract Infections drug therapy, Time-to-Treatment
Abstract

Objectives: To assess the effectiveness and safety of delayed antibiotic prescription (DAP) compared to immediate antibiotic prescription (IAP) and no antibiotic prescription (NAP) in children with uncomplicated respiratory infections., Methods: Randomized clinical trial comparing 3 antibiotic prescription strategies. The participants were children with acute uncomplicated respiratory infections attended to in 39 primary care centers. Children were randomly assigned into prescription arms as follows: (1) DAP, (2) IAP, or (3) NAP. Primary outcomes were symptom duration and severity. Secondary outcomes were antibiotic use, parental satisfaction, parental beliefs, additional primary care visits, and complications at 30 days., Results: In total, 436 children were included in the analysis. The mean (SD) duration of severe symptoms was 10.1 (6.3) for IAP, 10.9 (8.5) for NAP, and 12.4 (8.4) for DAP ( P = .539), although the differences were not statistically significant. The median (interquartile range) of the greatest severity for any symptom was similar for the 3 arms (median [interquartile range] score of 3 [2-4]; P = .619). Antibiotic use was significantly higher for IAP ( n = 142 [96%]) compared to DAP ( n = 37 [25.3%]) and NAP ( n = 17 [12.0%]) ( P < .001). Complications, additional visits to primary care, and satisfaction were similar for all strategies. Gastrointestinal adverse effects were higher for IAP., Conclusions: There was no statistically significant difference in symptom duration or severity in children with uncomplicated respiratory infections who received DAP compared to NAP or IAP strategies; however, DAP reduced antibiotic use and gastrointestinal adverse effects., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Published
2021
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