Consultations, (antibiotic) prescriptions, and productivity losses of patients with community-acquired respiratory tract infection: country-specific findings from the PRUDENCE trial

Abstract Objective Recent estimates of the cost-of-illness of community-acquired acute respiratory tract infections (CA-ARTI) are scarce. The current study aimed to estimate country-specific prescriptions, consultations, and productivity loss of patients with CA-ARTI in primary care. Methods Data were collected via baseline data and a patient diary alongside the PRUDENCE trial. This multinational clinical trial recruited patients visiting their general practitioner (GP) with CA-ARTI symptoms in ten countries. Data collected included the antibiotic class prescribed, consultations with healthcare providers, non-antibiotic medication prescribed for CA-ARTI, disease duration, and missed working hours. Hours of work missed due to the disease were multiplied by country-specific hourly labour cost to calculate productivity loss in terms of absenteeism. Results Proportions of CA-ARTI patients receiving an antibiotic prescription ranged from 37.2% in Germany to 68.2% in Ireland. Broad-spectrum penicillin was the most frequently prescribed class in Belgium, Germany, and Ireland (> 40%), whereas macrolides were most frequently prescribed in Georgia, Greece, and Hungary (> 36%). On average, approximately 50% of patients reported having a follow-up consultation with their GP within two weeks of the initial appointment. On average, work missed due to CA-ARTI was 15.4 h among employed patients, resulting in an average productivity loss of €358 per patient, and ranged from €1260 in Germany to €24 in Georgia. Conclusions Antibiotic prescriptions, healthcare use, and missed work hours for CA-ARTI were substantially different across participating countries. This study adds valuable information on the generalizability of health economic evidence regarding CA-ARTI between countries and indicates the relevance to collect country-specific data and perform country-specific health economic analyses.