Authors' objectives: HTW undertook an evidence review to address the following question: in people who present with an acute sore throat, what is the clinical and cost effectiveness of rapid antigen detection tests for diagnosing and managing suspected group A streptococcal infection in the community pharmacy setting? This review is in part adapted from diagnostics guidance produced by the National Institute for Health and Care Excellence (NICE), “Rapid tests for group A streptococcal infections in people with a sore throat”, published in 2019 (DG38).

Authors' results and conclusions: Evidence for the clinical effectiveness of RADT in community pharmacy, and the wider benefits of this to the system, was limited. No published evidence was found which looked at the use of RADT in community pharmacy compared to other healthcare settings, or reported on the diagnostic accuracy of using RADT in community pharmacy. Three new studies and a systematic review reporting the diagnostic accuracy of RADT in other healthcare settings had been published since the NICE review. Overall, studies were considered to have wide variation and provide weak evidence. One study was in press at the time of the review which used an ecological design to assess the effectiveness of RADT in community pharmacy. Primary care cluster areas offering the service saw a similar reduction in prescriptions for phenoxymethylpenicillin to those not (once pharmacy supplies were included) and no increase in the number of quinsy incidents was detected. In one practice, the average sore throat consultation rate decreased from 0.71 to 0.36 per 1,000 patients following introduction of the service in their area. HTW developed a de novo economic analysis to estimate the cost effectiveness of using RADT as part of a community pharmacy test-and-treat service for suspected group A streptococcal infection. This was based largely on the economic analysis conducted as part of NICE DG38 and made the assumption that pharmacists would be able to carry out RADT testing with the same level of effectiveness as a physician. The analysis indicated that a pharmacist test-and-treat service was likely to be more effective and less costly than usual care. The conclusion of the analysis was found to be robust in deterministic sensitivity analysis and in probabilistic sensitivity analysis, RADT was found to have a 100% probability of being cost effective at a threshold of £20,000 per QALY.

Authors' recommendations: The use of RADT within the community pharmacy setting for the diagnosis and management of people with group A streptococcal infections is promising. Nonetheless, the current evidence is limited and does not support routine adoption. Uncertainties remain about the clinical and cost effectiveness of the use RADT in all clinical settings. Some promising evidence has been collected on the use of RADTs in community pharmacies in Wales as part of a pilot of the NHS Wales Sore Throat Test and Treat Service but more definitive studies are required.

Authors' methods: This Evidence Appraisal Report is an adaptation of diagnostics guidance produced by the National Institute for Health and Care Excellence (NICE), “Rapid tests for group A streptococcal infections in people with a sore throat”, published in 2019, with an updated literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise the evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence of “lower priority” where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: Further research is recommended to demonstrate the clinical effectiveness of RADT in the community pharmacy setting.

Project Status: Completed

Year Published: 2020

URL for published report: https://www.healthtechnology.wales/reports-guidance/rapid-antigen-detecting-tests/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk

Copyright: Health Technology Wales