[C-Reactive Protein point-of-care testing (CRP-POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections]

Blasco-Amaro JA, Márquez-Peláez S, Castro Campos JL
Record ID 32018001469
Original Title: Eficacia, seguridad y efectividad de la determinación de la proteína C reactiva a la cabecera del paciente para las infecciones agudas del tracto respiratorio en atención primaria
Authors' objectives: This report aims to determine the efficacy, safety and effectiveness of portable rapid C-reactive protein point-of-care testing (CRP POCT) in capillary blood for the diagnosis of bacterial infection in primary care for respiratory tract infections. This need was prioritized from the Commission of Health Benefits, Assurance and Financing (CPAF in Spanish) dependent on the Interterritorial Council of the National Health System.
Authors' results and conclusions: The different sections of the original EUnetHTA report were adopted and those related to the burden of disease and the problems related to the prescription and use of antibiotics were adapted to our context. Finally, the section dealing with the economic aspects is the result of a de novo review of economic studies on the test. Regarding the clinical effectiveness and safety of POCT tests of CRP in patients attending with acute RTIs in primary care, the systematic review carried out by the authors in the EUnetHTA report allows them to conclude with moderate safety, that their use leads to a significant reduction in the prescription of antibiotics compared to standard care. This reduction in prescription is achieved without compromising patient safety, without showing an increase in hospitalizations or mortality among patients. These findings are based on short-term data. More research is needed to validate these results in demographic subgroups such as children and older adults (> 65 years), and in different primary care settings where the spectrum of attending patients may be different. The diagnostic validity was analyzed in the EUnetHTA report for indications such as sinusitis, pharyngitis, tonsillitis and pneumonia. The evidence obtained for the diagnostic validity of POCT in primary care is characterized by a high level of heterogeneity in patients, the criteria for diagnosis, cut-off points of POCT, how the performance of the test is measured and the absence of a universal reference standard for the diagnosis of respiratory tract infection requiring treatment with antibiotics. Regarding the economic aspects, the analyzed studies showed potential savings in antibiotic treatment with the use of the test or an incremental cost-effectiveness ratio, when available, below the usual decision thresholds. From the conclusions obtained, we can claim that after considering the data from the environment in Spain, the conclusions of the original EUnetHTA report can be maintained, that is, being moderately sure that their use brings about a significant reduction in the prescription of antibiotics compared to standard clinical practice.
Authors' methods: To answer the questions about (1) the description of the diagnostic technology, (2) the effectiveness of the CRP POCT determination to guide the antibiotic prescription in patients with acute respiratory tract disease in primary care and (3) the diagnostic validity of the PCR POCT test in patients with acute respiratory tract infection in primary care, the method of adoption of the referred document has been used following the manual "Guide for the elaboration and adaptation of rapid reports of health technologies assessment", 2016.
Project Status: Completed
Year Published: 2020
Requestor: Spanish Health Ministry
English language abstract: An English language summary is available
Publication Type: Full HTA
Country: Spain
MeSH Terms
  • Biomarkers
  • C-Reactive Protein
  • Point-of-Care Systems
  • Respiratory Tract Infections
Organisation Name: Andalusian Health Technology Assessment Area
Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309
Contact Name: aetsa.csalud@juntadeandalucia.es
Contact Email: aetsa.csalud@juntadeandalucia.es
Copyright: Andalusian Agency for Health Technology Assessment (AETSA)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.