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Cost‐effectiveness analysis of a multi‐dimensional intervention to reduce inappropriate antibiotic prescribing for children with upper respiratory tract infections in China
Author(s) -
Zhang Zhitong,
Dawkins Bryony,
Hicks Joseph P.,
Walley John D.,
Hulme Claire,
Elsey Helen,
Deng Simin,
Lin Mei,
Zeng Jun,
Wei Xiaolin
Publication year - 2018
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13132
Subject(s) - medicine , medical prescription , respiratory tract infections , emergency medicine , intervention (counseling) , cost effectiveness , psychological intervention , average cost , health care , family medicine , pediatrics , nursing , risk analysis (engineering) , respiratory system , economics , economic growth , neoclassical economics
Summary Background We developed a multifaceted intervention to reduce antibiotic prescription rate for children with upper respiratory tract infections ( URTI s) among primary care doctors in township hospitals in China. The intervention achieved a 29% (95% CI 16–42) absolute risk reduction in antibiotic prescribing. This study was to assess the cost‐effectiveness of our intervention at reducing antibiotic prescribing in rural primary care facilities as measured by the intervention's effect on the antibiotic prescription rates for childhood URTI s. Methods We took a healthcare provider perspective, measuring costs of consultation (time cost of doctor), prescription monitoring process and peer‐review meetings (time cost of participants) and medication costs. Costs on provider side were collected through a bespoke questionnaire from all 25 township hospitals in December 2016, while medication costs were collected prospectively in the trial. Incremental cost‐effectiveness ratios were calculated by dividing the mean difference in cost of the two trial arms by the mean difference in antibiotic prescribing rate. Results This showed an incremental cost of $0.03 per percentage point reduction in antibiotic prescribing. In addition to this incremental cost, the cost of implementing the intervention, including training and materials delivered by township hospitals, was $390.65 ( SD $145.68) per healthcare facility. Conclusions This study shows that a multifaceted intervention programme, when embedded into routine practice, is very cost‐effective at reducing antibiotic prescribing in primary care facilities and has the potential of scale up in similar resource limited settings.