• Question: Hi Can you let me know what evidence exists for the cost-effectiveness of near patient CRP testing for infections in primary care, and also the availability of such testing kits? Many thanks Sarah

    Asked by saraht to Thamarai, Rose, Paul, Michael, Martin, , , Jeroen, Elizabeth, Cliodna, Chris, Andrew, Alastair, Adam on 15 Nov 2015.
    • Photo: Paul Little

      Paul Little answered on 16 Nov 2015:


      There is evidence from the trial by Jochen Cals and Colleagues that both training in CRP use and in communication skills are likely to be very cost-effective (DOI: 10.1111/j.1365-2753.2010.01472.x), and there are a range of kits available from several companies (e.g. Orion; Alere).

    • Photo: Michael Moore

      Michael Moore answered on 17 Nov 2015:


      In the trials so far CRP testing has led to a substantial reduction in antibiotic prescribing for lower respiratory tract infection. There is not good evidence at the moment in support of its use for other respiratory infections (e.g. sore throat or sinusitis) so although it may be tempting its use should be restricted to LRTI where the diagnosis is uncertain and antibiotics are being considered.
      The cost per test is now around £5-6 so it is inexpensive but at the moment in the UK that cost will be borne by the practice whilst any cost savings for reduced prescribing will be realised by the CCG. Of course most antibiotics for RTI are inexpensive but the potential costs of future antibiotic resistance are huge so estimates of cost effectiveness have to look beyond the immediate costs of test and drugs.

    • Photo: Cliodna McNulty

      Cliodna McNulty answered on 17 Nov 2015:


      I agrre with Mike and Paul,
      the cost effectiveness of these tests is likely to be greater in higher prescribing practices.
      It would be worth CCGs asking their high prescribing practices to do some audits of antibiotics in acute cough. If this is high then it may well be worth considering introducing a trial of CRP in these practices.
      the audit templates for acute cough are available on the TARGET website at
      http://www.rcgp.org.uk/clinical-and-research/toolkits/~/link.aspx?_id=4725F0AA89A349E991425E510F7D6371&_z=z

    • Photo: Christopher Butler

      Christopher Butler answered on 18 Nov 2015:


      See this primary reference and this review!

      J Eval Clin Pract. 2011 Dec;17(6):1059-69. doi: 10.1111/j.1365-2753.2010.01472.x. Epub 2010 Jul 8.
      C-reactive protein point of care testing and physician communication skills training for lower respiratory tract infections in general practice: economic evaluation of a cluster randomized trial.
      Cals JW1, Ament AJ, Hood K, Butler CC, Hopstaken RM, Wassink GF, Dinant GJ.

      Adv Ther. 2015; 32: 69–85.
      Published online 2015 Jan 27. doi: 10.1007/s12325-015-0180-x
      PMCID: PMC4311066
      Cost-Effectiveness of Point-of-Care C-Reactive Protein Tests for Respiratory Tract Infection in Primary Care in England
      Rachael Hunter

    • Photo: Andrew Hayward

      Andrew Hayward answered on 18 Nov 2015:


      Although there is some evidence that CRP tests can reduce prescribing amongst those who visit their GP, one of the potential issues in using such near patient diagnostic tests to guide prescribing decisions is that if used routinely for minor infections this may further reinforce the feeling that it is necessary to consult for these infections and to further “medicalise” the problem.

    • Photo: Elizabeth Beech

      Elizabeth Beech answered on 18 Nov 2015:


      I agree with Andrew’s reply, about transferring dependance from an expectation of an antibiotic to a test.
      I feel if CRP testing was a drug, its evidence base would not pass the formulary processes, and it would require more robust evidence base to be adopted into regular use. I wonder what a trial of CRP vs Back up prescription would show from a cost effective perspective. Michael and I have discussed CRP in the past when the NICE CG for Pneumonia were published – would CRP be of use in a large community pharmacy setting (great patient 7 day access) to triage appropriate patients to GP care, so reducing avoidable visits to busy practice settings. The TARGET Treating Your Infection leaflet has been adapted for use by community pharmacies, so might be a model to consider piloting.

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