scholarly journals Economic considerations support C-reactive protein testing alongside malaria rapid diagnostic tests to guide antimicrobial therapy for patients with febrile illness in settings with low malaria endemicity

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Yoel Lubell ◽  
Arjun Chandna ◽  
Frank Smithuis ◽  
Lisa White ◽  
Heiman F. L. Wertheim ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Therapy ◽  
Diagnostic Tests ◽  
Distribution Systems ◽  
Point Of Care ◽  
Febrile Illness ◽  
Cost Effective ◽  
Rapid Diagnostic Tests ◽  
C Reactive Protein ◽  
Reactive Protein

AbstractMalaria is no longer a common cause of febrile illness in many regions of the tropics. In part, this success is a result of improved access to accurate diagnosis and effective anti-malarial treatment, including in many hard-to-reach rural areas. However, in these settings, management of other causes of febrile illness remains challenging. Health systems are often weak and other than malaria rapid tests no other diagnostics are available. With millions of deaths occurring annually due to treatable bacterial infections and the ever increasing spread of antimicrobial resistance, improvement in the management of febrile illness is a global public health priority. Whilst numerous promising point-of-care diagnostics are in the pipeline, substantial progress can be made in the interim with existing tools: C-reactive protein (CRP) is a highly sensitive and moderately specific biomarker of bacterial infection and has been in clinical use for these purposes for decades, with dozens of low-cost devices commercially available. This paper takes a health-economics approach to consider the possible advantages of CRP point-of-care tests alongside rapid diagnostic tests for malaria, potentially in a single multiplex device, to guide antimicrobial therapy for patients with febrile illness. Three rudimentary assessments of the costs and benefits of this approach all indicate that this is likely to be cost-effective when considering the incremental costs of the CRP tests as compared with either (i) the improved health outcomes for patients with bacterial illnesses; (ii) the costs of antimicrobial resistance averted; or (iii) the economic benefits of better management of remaining malaria cases and shorter malaria elimination campaigns in areas of low transmission. While CRP-guided antibiotic therapy alone cannot resolve all challenges associated with management of febrile illness in remote tropical settings, in the short-term a multiplexed CRP and malaria RDT could be highly cost-effective and utilize the well-established funding and distribution systems already in place for malaria RDTs. These findings should spark further interest amongst industry, academics and policy-makers in the development and deployment of such diagnostics, and discussion on their geographically appropriate use.

scholarly journals Cost-Effectiveness Analysis of the Use of Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing in Primary Care

Antibiotics ◽  
2018 ◽  
Vol 7 (4) ◽  
pp. 106 ◽  
Author(s):  
Emily Holmes ◽  
Sharman Harris ◽  
Alison Hughes ◽  
Noel Craine ◽  
Dyfrig Hughes
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Respiratory Tract ◽  
Clinical Guidelines ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Cost Effective ◽  
Routine Practice ◽  
C Reactive Protein ◽  
Reactive Protein

More appropriate and measured use of antibiotics may be achieved using point-of-care (POC) C-reactive protein (CRP) testing, but there is limited evidence of cost-effectiveness in routine practice. A decision analytic model was developed to estimate the cost-effectiveness of testing, compared with standard care, in adults presenting in primary care with symptoms of acute respiratory tract infection (ARTI). Analyses considered (1) pragmatic use of testing, reflective of routine clinical practice, and (2) testing according to clinical guidelines. Threshold and scenario analysis were performed to identify cost-effective scenarios. In patients with symptoms of ARTI and based on routine practice, the incremental cost-effectiveness ratios of CRP testing were £19,705 per quality-adjusted-life-year (QALY) gained and £16.07 per antibiotic prescription avoided. Following clinical guideline, CRP testing in patients with lower respiratory tract infections (LRTIs) cost £4390 per QALY gained and £9.31 per antibiotic prescription avoided. At a threshold of £20,000 per QALY, the probabilities of POC CRP testing being cost-effective were 0.49 (ARTI) and 0.84 (LRTI). POC CRP testing as implemented in routine practice is appreciably less cost-effective than when adhering to clinical guidelines. The implications for antibiotic resistance and Clostridium difficile infection warrant further investigation.

Innovations in point of care testing for bacterial infections: The Longitude Prize with Daniel Berman

2020 ◽  
Author(s):  
Daniel Berman
Keyword(s):  
Antimicrobial Resistance ◽  
Diagnostic Tests ◽  
Bacterial Infections ◽  
Point Of Care ◽  
Rapid Diagnostic Tests ◽  
Public Healthcare ◽  
Point Of Care Testing ◽  
Set Up ◽  
Insight Into

Antimicrobial resistance (AMR) is one of the most serious clinical and public healthcare challenges. In this video Daniel Berman,  Nesta Challenges, provides an overview of the Longitude Prize, why the prize was set up and what the prize hopes to achieve. Daniel also provides insight into some of the rapid diagnostic tests currently in the running for the £8 million prize.

scholarly journals DENGUE RAPID DIAGNOSTIC TESTS;

2017 ◽  
Vol 24 (08) ◽  
pp. 1216-1223
Author(s):  
Aneela Altaf Kidwai ◽  
Jamal Ara ◽  
Samina Ghaznawi ◽  
Shumaila Abdul Rasheed ◽  
Saleemullah Paracha ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Point Of Care ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Hemorrhagic Fever ◽  
Cross Sectional Study ◽  
Rapid Diagnostic Tests ◽  
Case Definition ◽  
Cross Sectional

Objectives: To determine the point of care role of dengue IgA and Dengue IgM/ IgG rapid diagnostic tests (RDTs) in a tertiary care setting in terms of day of onset of illness atpresentation and frequency of positive RDTs in dengue hemorrhagic fever (DHF) and dengueshock syndrome (DSS). Study Design: Cross-sectional study. Setting: Abbasi ShaheedHospital, Karachi. Period: August-2014 to January-2016. Method: Patients aged 13years andabove with acute febrile illness, fulfilling the WHO case definition criteria of probable DF andDHF were included. Two immunochromatograpic (ICT) based RDTs, Assure dengue IgA andPanbio Dengue Duo Cassette (IgM / IgG) were used. Dengue IgA was employed in all patientsfrom day 2 of illness whereas IgM / IgG was employed after day 4 of onset of fever. Result:Among 174 probable cases, 108 (62%) presented between 2 – 5 days of onset of fever, amongwhom 87 (80.5%) were found to be dengue IgA positive. Sixty-nine (39.65%) patients had DHF,among whom 97.1% were seropositive for IgA. Of 118 patients presented after 4 days of onsetof illness, 59.3% were positive by IgM / IgG rapid assay. Conclusion: Considering the higherfrequency of secondary dengue and DHF in dengue endemic-hyperendemic regions, IgAbased ICT might be a helpful diagnostic assay for early diagnosis of dengue infection.

Low-Cost Thermal Shield for Rapid Diagnostic Tests Using Phase Change Materials

2018 ◽  
Vol 12 (1) ◽  
Author(s):  
Luis R. Soenksen ◽  
David A. Martínez-Corona ◽  
Sofía Iñiguez de Gante ◽  
Pierre S. Phabmixay ◽  
Mauricio J. Marongiu Maggi
Keyword(s):  
Phase Change ◽  
Diagnostic Tests ◽  
Phase Change Materials ◽  
Point Of Care ◽  
Low Cost ◽  
Cost Effective ◽  
Rapid Diagnostic Tests ◽  
Cold Chain ◽  
Thermal Shield ◽  
Tropical Regions

The shelf life of point-of-care and rapid diagnostic tests (POC-RDTs) is commonly compromised by abrupt temperature changes during storage, transportation, and use. This situation is especially relevant in tropical regions and resource-constrained settings where cold chain may be unreliable. Here, we report the use of novel and low-cost passive thermal shield (TS) made from laminated phase change material (PCM) to reduce thermal overload in POC-RDTs. Validation of the proposed design was done through numerical simulation and testing of an octadecane shield prototype in contact with a lateral flow immunoassay. The use of our TS design provided 30–45 min delay in thermal equilibration under constant and oscillating heat load challenges resembling those of field use. The addition of a thin PCM protection layer to POC-RDTs can be a cost-effective, scalable, and reliable solution to provide additional thermal stability to these devices.

scholarly journals Near-Patient Test for C-Reactive Protein in General Practice: Assessment of Clinical, Organizational, and Economic Outcomes

1999 ◽  
Vol 45 (4) ◽  
pp. 478-485 ◽  
Author(s):  
Bjarne Steen Dahler-Eriksen ◽  
Torsten Lauritzen ◽  
Jens Flensted Lassen ◽  
Erik D Lund ◽  
Ivan Brandslund
Keyword(s):  
General Practice ◽  
Point Of Care ◽  
Cost Effective ◽  
Economic Outcomes ◽  
C Reactive Protein ◽  
Blood Samples ◽  
Telephone Consultation ◽  
Hospital Laboratory ◽  
Reactive Protein ◽  
Study Results

Abstract Background: The benefits of near-patient, point-of-care tests have not been fully examined. We have assessed the clinical, organizational, and economic outcomes of implementing a near-patient test for C-reactive protein (CRP) in general practice. Methods: In a randomized crossover trial during intervention periods, general practitioners (GPs) were allowed to measure CRP within 3 min, using NycoCard® CRP. During control periods, they had to mail blood samples for CRP measurements to the hospital laboratory and received test results 24–48 h later. Twenty-nine general practice clinics participated (64 GPs), and 1853 patients were included in the study. Results were evaluated at both the level of participating GPs and the level of included patients. Results: For participating GPs, the overall use of erythrocyte sedimentation rates (ESRs) decreased by 8% (95% confidence interval, 1–14%) during intervention periods, and the number of blood samples mailed to the hospital laboratory decreased by 6% (1–10%). No reduction in the prescription of antibiotics was seen. The proportion of study patients having a follow-up telephone consultation was reduced from 63% to 53% (P = 0.0001), and patients with CRP concentrations >50 mg/L had their antibiotic treatments started earlier when CRP was measured in general practices (P = 0.0161). Conclusion: The implementation of the near-patient CRP test was cost-effective mainly on the basis of a reduction in the use of services from the hospital laboratory by GPs. If the implementation is followed by education and clinical guidelines, opportunities exist for additional reduction in the use of ESR and for a more appropriate use of antibiotics.

scholarly journals Implementation of C-reactive protein point of care testing to improve antibiotic targeting in respiratory illness in Vietnamese primary care (ICAT): a study protocol for a cluster randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040977
Author(s):  
Nga Thi Thuy Do ◽  
Rachel Claire Greer ◽  
Yoel Lubell ◽  
Sabine Dittrich ◽  
Maida Vandendorpe ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Antibiotic Use ◽  
Routine Care ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Randomised Controlled

IntroductionC-reactive protein (CRP), a biomarker of infection, has been used widely in high-income settings to guide antibiotic treatment in patients presenting with respiratory illnesses in primary care. Recent trials in low- and middle-income countries showed that CRP testing could safely reduce antibiotic use in patients with non-severe acute respiratory infections (ARIs) and fever in primary care. The studies, however, were conducted in a research-oriented context, with research staff closely monitoring healthcare behaviour thus potentially influencing healthcare workers’ prescribing practices. For policy-makers to consider wide-scale roll-out, a pragmatic implementation study of the impact of CRP point of care (POC) testing in routine care is needed.Methods and analysisA pragmatic, cluster-randomised controlled trial, with two study arms, consisting of 24 commune health centres (CHC) in the intervention arm (provision of CRP tests with additional healthcare worker guidance) and 24 facilities acting as controls (routine care). Comparison between the treatment arms will be through logistic regression, with the treatment assignment as a fixed effect, and the CHC as a random effect. With 48 clusters, an average of 10 consultations per facility per week will result in approximately 520 over 1 year, and 24 960 in total (12 480 per arm). We will be able to detect a reduction of 12% to 23% or more in immediate antibiotic prescription as a result of the CRP POC intervention. The primary endpoint is the proportion of patient consultations for ARI resulting in immediate antibiotic prescription. Secondary endpoints include the proportion of all patients receiving an antibiotic prescription regardless of ARI diagnosis, frequency of re-consultation, subsequent antibiotic use when antibiotics are not prescribed, referral and hospitalisation.Ethics and disseminationThe study protocol was approved by the Oxford University Tropical Research Ethics Committee (OxTREC, Reference: 53–18), and the ethical committee of the National Hospital for Tropical Diseases in Vietnam (Reference:07/HDDD-NDTW/2019). Results from this study will be disseminated via meetings with stakeholders, conferences and publications in peer-reviewed journals. Authorship and reporting of this work will follow international guidelines.Trial registration detailsNCT03855215; Pre-results.

scholarly journals Demonstration of a Label-Free and Low-Cost Optical Cavity-Based Biosensor Using Streptavidin and C-Reactive Protein

Biosensors ◽  
2020 ◽  
Vol 11 (1) ◽  
pp. 4
Author(s):  
Donggee Rho ◽  
Seunghyun Kim
Keyword(s):  
Limit Of Detection ◽  
Point Of Care ◽  
Low Cost ◽  
Optical Cavity ◽  
Sample Volume ◽  
Small Sample ◽  
Label Free ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Cavity Structure

An optical cavity-based biosensor (OCB) has been developed for point-of-care (POC) applications. This label-free biosensor employs low-cost components and simple fabrication processes to lower the overall cost while achieving high sensitivity using a differential detection method. To experimentally demonstrate its limit of detection (LOD), we conducted biosensing experiments with streptavidin and C-reactive protein (CRP). The optical cavity structure was optimized further for better sensitivity and easier fluid control. We utilized the polymer swelling property to fine-tune the optical cavity width, which significantly improved the success rate to produce measurable samples. Four different concentrations of streptavidin were tested in triplicate, and the LOD of the OCB was determined to be 1.35 nM. The OCB also successfully detected three different concentrations of human CRP using biotinylated CRP antibody. The LOD for CRP detection was 377 pM. All measurements were done using a small sample volume of 15 µL within 30 min. By reducing the sensing area, improving the functionalization and passivation processes, and increasing the sample volume, the LOD of the OCB are estimated to be reduced further to the femto-molar range. Overall, the demonstrated capability of the OCB in the present work shows great potential to be used as a promising POC biosensor.

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