Authors' objectives: This report aims to identify and summarise evidence that addresses the following question: What is the clinical and cost effectiveness of rapid antigen detection tests for diagnosing and managing suspected group A streptococcal sore throat infection in the community pharmacy setting?

Authors' results and conclusions: Overall, there was evidence from two ecological studies suggesting that antibiotic prescribing rates were lower for a community pharmacy service using confirmatory point-of-care rapid antigen detection tests (RADTs) than for a community pharmacy service that did not. A reduction in antibiotic prescribing rates was observed in all patients presenting to the service, and also in patients with FeverPAIN scores of 4 or more. There was also evidence from a longitudinal cohort study that antibiotic prescribing rates were lower for a community pharmacy service using confirmatory point-of-care RADTs than for initial consultations conducted at GP practices, both on the initial date and within 28 days of presentation. There was evidence from the same longitudinal cohort that rates of GP re-consultation were higher for the community pharmacy service, compared to initial GP consultations. A patient satisfaction survey conducted in the same community pharmacy service reported high levels of satisfaction with the service. No evidence was found for health related quality of life. Community pharmacies using RADTs for people presenting with a sore throat was estimated to be cost effective compared to standard general practitioner (GP) assessment. Cost effectiveness remained uncertain compared to community pharmacies not using RADTs, because the wider health benefits of reducing antibiotic prescribing, such as impacts on antimicrobial resistance, cannot be robustly captured in standard health economic modelling frameworks. The patient evidence shows that, overall, patients tolerate RADT and other forms of swab-testing and are accepting of both pharmacy-led services and of measures taken to reduce overprescription of antibiotics. However, some concerns were expressed: some patients are concerned that they may not get access to antibiotics they view as necessary for their health, and others are concerned about unintended consequences of moving services from GP clinics to pharmacies, such as missed safeguarding opportunities. Three meta-analyses of primary studies for tests known to be used in the Sore Throat Test and Treat Service (STTT) estimated sensitivities ranging from 83% to 92% and specificities from 93% to 96%.

Authors' recommendations: NHS Wales should routinely offer rapid antigen detection tests for group A streptococcal infections to treat people with a sore throat in the community pharmacy setting.

Authors' methods: The Evidence Appraisal Report is based on a 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 this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence 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. A patient, carer and family considerations (PPI) review was conducted, using similar methods.

Authors' identified further research: No research recommendations were made by the Appraisal Panel.

Project Status: Completed

Year Published: 2026

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