Cost-effectiveness of internet-based training for primary care clinicians on antibiotic prescribing for acute respiratory-tract infections in Europe

Objectives: Overprescribing of antibiotics by general practitioners is seen as a major driver of antibiotic resistance. Training in communication skills and C-reactive protein (CRP) testing both appear effective in reducing such prescribing. This study assesses the cost-effectiveness of (i) training general practitioners (GPs) in the use of CRP testing, (ii) training GPs in communication skills and (iii) training GPs in both CRP testing and communication skills compared to usual care.
Methods: Economic analyses (cost-utility analysis (CUA) accounting for the cost of antibiotic resistance and cost-effectiveness analysis (CEA)) were both conducted from a health care perspective with a time horizon of 28 days alongside a multinational, cluster, randomised, factorial controlled trial in patients with respiratory tract infections in five European countries. The primary outcome measures were QALYs and percentage reductions in antibiotic prescribing. Hierarchical modelling was used to estimate an incremental cost-per-QALY-gained and an incremental cost-per-percentage-reduction in antibiotic prescribing.
Results: Overall, the results of both the CUA and CEA showed that training in communication skills is the most cost-effective. However, excluding the cost of antibiotic resistance in the CUA resulted in usual care being the most cost-effective option. Country-specific results from the CUA showed that training in communication skills was cost-effective in Belgium, UK and Netherlands whilst training in CRP was cost-effective in Poland.
Conclusion: Internet-based training in communication skills is a cost-effective intervention to reduce antibiotic prescribing for respiratory tract infections in primary care if the cost of antibiotic resistance is accounted for.