Trial reportThe British journal of general practice : the journal of the Royal College of General Practitioners2016
Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance.
Trial report in The British journal of general practice : the journal of the Royal College of General Practitioners, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
34 citing papers in PubMed, 5 syntheses or guidelines pooled it, 68 citations in OpenAlex.
- Economic Evaluation of Interventions to Reduce Antimicrobial Resistance: A Systematic Literature Review of Methods.PharmacoEconomics · 2025Pooled it
- A systematic literature review of economic evaluation studies of interventions impacting antimicrobial resistance.Antimicrobial resistance and infection control · 2023Pooled it
- Economic evaluation of antimicrobial resistance in curable sexually transmitted infections; a systematic review and a case study.PloS one · 2023Pooled it
- The impact of acute pneumococcal disease on health state utility values: a systematic review.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2022Pooled it
- Economic Analyses of Respiratory Tract Infection Diagnostics: A Systematic Review.PharmacoEconomics · 2021Pooled it
- Cost-effectiveness analysis of procalcitonin and lung ultrasonography guided antibiotic prescriptions in primary care.The European journal of health economics : HEPAC : health economics in prevention and care · 2025Trial
- Trial
- Trial
- Antibiotics for lower respiratory tract infection in children presenting in primary care in England (ARTIC PC): a double-blind, randomised, placebo-controlled trial.Lancet (London, England) · 2021Trial
- Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections (AnTIC): a randomised, open-label trial.The Lancet. Infectious diseases · 2018Trial
- Point-of-care urine culture for managing urinary tract infection in primary care: a randomised controlled trial of clinical and cost-effectiveness.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Trial
- Health Utilities Associated with Pneumococcal Diseases in Children and Adults: A Targeted Literature Review and Meta-analysis.PharmacoEconomics - open · 2026Review
- Article
- Global Assessment of Health Utilities Associated with Pneumococcal Disease in Adults: Targeted Literature Reviews.PharmacoEconomics - open · 2026Review
- Existing Evidence from Economic Evaluations of Antimicrobial Resistance-A Systematic Literature Review.Antibiotics (Basel, Switzerland) · 2025Review
- A cost-effectiveness analysis of two psychological treatments for controlled drinking in individuals alcohol use disorder.Cost effectiveness and resource allocation : C/E · 2025Article
- The cost-effectiveness of procalcitonin for guiding antibiotic prescribing in individuals hospitalized with COVID-19: part of the PEACH study.The Journal of antimicrobial chemotherapy · 2024Article
- Overcoming challenges in the economic evaluation of interventions to optimise antibiotic use.Communications medicine · 2024Review
- C-reactive protein point-of-care testing in primary care-broader implementation needed to combat antimicrobial resistance.Frontiers in public health · 2024Review
- A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.BMC pediatrics · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 7 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLower respiratory tract infections (LRTIs) are a major disease burden and are often treated with antibiotics. Typically, studies evaluating the use of antibiotics focus on immediate costs of care, and do not account for the wider implications of antimicrobial resistance.
aimThis study sought to establish whether antibiotics (principally amoxicillin) are cost effective in patients with LRTIs, and to explore the implications of taking into account costs associated with resistance. DESIGN AND
settingMultinational randomised double-blinded trial in 2060 patients with acute cough/LRTIs recruited in 12 European countries.
methodA cost-utility analysis from a health system perspective with a time horizon of 28 days was conducted. The primary outcome measure was the quality-adjusted life year (QALY). Hierarchical modelling was used to estimate incremental cost-effectiveness ratios (ICERs).
resultsAmoxicillin was associated with an ICER of €8216 (£6540) per QALY gained when the cost of resistance was excluded. If the cost of resistance is greater than €11 (£9) per patient, then amoxicillin treatment is no longer cost effective. Including possible estimates of the cost of resistance resulted in ICERs ranging from €14 730 (£11 949) per QALY gained - when only multidrug resistance costs and health care costs are included - to €727 135 (£589 856) per QALY gained when broader societal costs are also included.
conclusionEconomic evaluation of antibiotic prescribing strategies that do not include the cost of resistance may provide misleading results that could be of questionable use to policymakers. However, further work is required to estimate robust costs of resistance.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.