Influence on Antibiotic Prescribing and Cost Effects Through Standardized Implementation of PoC Testing in Adults With Sore Throats in Standard SHI Care

OBJECTIVES: Sore throat, symptom of acute pharyngitis (AP), is one of the main causes of GP visits in Germany. 46% of patients with AP receive an antibiotic (AB) prescription after GP consultation. However, only 15-30% of AP are caused by bacteria, mainly group-A-streptococci, which could be detected by point-of-care (PoC)-tests. Studies show that AB are only prescribed in 20% of cases if a PoC-test has been carried out beforehand. However, the tests are currently very rarely used in adults as they are not reimbursed. The analysis aims to show how the reimbursement of PoC-tests in case of sore throat affects AB prescribing and costs from the perspective of SHI and SHI-insured community.

METHODS: Based on the patient population for which an AB prescription is considered according to the DEGAM guideline, the current status quo without reimbursement of PoC-tests was compared with the SHI reimbursement scenario using a decision tree. The model included the options of using PoC-tests, prescription of AB and recommendation of symptom-relieving OTCs. Both probabilities and costs were determined for each path. The budget effects were calculated from SHI and SHI-insured community perspective. Additionally, the influence of using PoC-Tests on the number of AB prescriptions and AB prescriptions without bacterial infection was determined. Sensitivity analyses were performed.

RESULTS: From the perspective of SHI or the SHI-insured community, reimbursement of PoC-tests results in an average reduction in intervention costs of 51 and 67 ct respectively. AB prescriptions can be reduced by around 40% compared to status quo. AB prescriptions in patients without bacterial infection are reduced by almost 85%. The results of the sensitivity analyses show robustness.

CONCLUSIONS: Reimbursement of Strep-A-tests in GP practices proves to be a dominant strategy compared to non-reimbursement: Prescription of non-indicated AB for pharyngitis can be reduced without incurring additional costs for the SHI or the SHI-insured community.