Table 4

Studies assessing cost-effectiveness of CRP testing in LMICs

StudyCountryAssumptionsResults
Studies in South-East Asia
Lubell et al27Laos
  •  Patients with CRP >20 mg/L or positive scrub typhus RDT are prescribed an antibiotic; patients with positive dengue RDT do not receive antibiotics.

  •  If tests are negative, antibiotics are prescribed at a rate of 38%

  •  Mean cost of CRP test was US$1.5, mean cost of a course of antibiotics was US$0.5.

  •  Mortality rate for bacterial infections without appropriate treatment was 1% (each death represents a mean loss of 45 life-years).

  •  Self-limiting/treated infections have a disability weight of 0.053.

  •  CRP RDT prevented 0.017 DALYs.

  •  Median ICER for CRP RDT was US$94.

  •  CRP testing is likely to be cost-effective even at low willingness-to-pay thresholds.

  •  The CRP tests was approximately 80% likely to be cost-effective at a willingness-to-pay threshold of US$1400 (approximating the Laos GDP/capita).

Lubell et al29Vietnam
  •  Unit cost of US$0.5 to US$3 per CRP test.

  •  Economic cost of AMR of US$0 to US$14 per full course.

  •  No difference in clinical outcomes between CRP-tested and non-CRP-tested patients, benefits relate only to the societal costs of AMR averted due to lower prescribing.

  •  At an AMR cost of US$4.1 and unit costs of US$0.5, CRP testing has a positive net-benefit if adherence to test results is >70%.

  •  At an AMR cost of US$4.1 and unit costs of US$1, CRP testing has a positive net-benefit if adherence to test results is ≥80%.

  •  A higher AMR cost of US$14.1 implies a positive net-benefit if adherence is >60%, even at US$3 per unit.

  • AMR, antimicrobial resistance; CRP, C reactive protein; DALY, disability-adjusted life-years; GDP, gross domestic product; ICER, incremental cost-effectiveness ratio; LMICs, low-income and middle-income countries; RDT, rapid diagnostic test.