Respiratory Syncytial Virus (RSV) infections in England: estimating the burden of antibiotic prescriptions, healthcare utilisation and associated costs.

Date of Approval: 
2021-03-09 00:00:00
Lay Summary: 
Antibiotic consumption is a crucial driver of antimicrobial resistance (AMR). Within England, most antibiotic prescribing occurs within primary care, with the majority prescribed for respiratory conditions, of which viruses cause many. Therefore, viral vaccination programmes hold promise as an intervention that can also optimise antibiotic use. Respiratory Syncytial Virus (RSV) is a leading cause of respiratory tract infections (RTI) in young children and older adults. While some health-economic evaluations exist for RSV vaccines currently under development, these studies ignored the potential impact on antibiotic use and resistance. This research aims to understand how many, and which antibiotics are prescribed for RSV infections as not all antibiotics select equally for resistance against clinically significant antibiotics. Also, quantify the total healthcare utilisation and costs of RSV infections to inform cost-effectiveness evaluations. Accurately estimating the burden of RSV infections requires analysis of routine healthcare records in combination with confirmed laboratory surveillance. This research will use time-series models of routine primary care records linked with secondary care records from the Clinical Practice Research Datalink (CPRD) alongside national microbiology surveillance from the Second-Generation Surveillance system (SGSS) database and Respiratory Datamart (RDMS) database to inform three studies. No linkage will be required between healthcare records and laboratory surveillance databases. Healthcare contacts and laboratory surveillance between 2015-2020 will be analysed. Findings could help improve antibiotic prescribing practice for patients presenting with an RTI and will inform cost-effectiveness models of RSV vaccines that include the impact of antibiotic use and AMR within England.
Technical Summary: 
Background: Respiratory Syncytial Virus (RSV) is associated with high healthcare utilisation and antibiotic prescribing within England. Therefore, RSV vaccines could act as an intervention to reduce RSV burden and support antibiotic use optimisation. Reduction of antibiotic use in primary care is a cornerstone of antimicrobial stewardship interventions aiming to curb the rise in AMR. Quantification of the impact of RSV vaccines on AMR does not exist. More research is required to inform cost-effectiveness models of RSV vaccines that can include AMR outcomes. RSV primary care antibiotic prescribing by antibiotic type and RSV healthcare utilisation that includes A&E attendances, outpatient appointments and associated costs for all age groups is unknown. Research questions 1. What antibiotics and how many are attributable to RSV infections in England? 2. What healthcare services and how many contacts are attributable to RSV infections in England? 3. What is the total cost of RSV-associated healthcare utilisation in England? 4. How does RSV primary care antibiotic prescribing, and health utilisation costs vary according to primary care antibiotic prescribing volume of general practices within England? Methods: Study 1: Time series analysis of primary care antibiotic prescriptions (CPRD) with corresponding surveillance of key respiratory pathogens (SGSS & RDMS) – no linkage - will estimate the proportion of primary care prescriptions attributable to RSV infections by antibiotic type. Study 2: Time series analysis of healthcare contacts with corresponding surveillance of key respiratory pathogens (SGSS & RDMS) - no linkage - will estimate the proportion of healthcare contacts and associated total cost attributable to RSV infections. Study 3: Multilevel models will explore RSV antibiotic prescribing and RSV healthcare utilisation costs by primary care antibiotic prescribing volume. Healthcare contacts will be based on GP consultations (CPRD), A&E attendances, hospital admissions and outpatient appointments (Hospital Episode Statistics (HES)).
Health Outcomes to be Measured: 
Study 1: (Primary outcomes) Primary care antibiotic prescriptions attributable to RSV described by antibiotic class; Respiratory primary care antibiotic prescriptions attributable to RSV; (Secondary outcomes) All acute primary care antibiotic prescriptions attributable to RSV; Specific respiratory primary care antibiotic prescriptions, with potential importance for resistance, attributable to RSV. Study 2: (Primary outcomes) Respiratory general practice consultations and associated costs attributable to RSV; All-cause A&E attendances and associated costs attributable to RSV; Respiratory hospital admissions and associated costs attributable to RSV; All-cause outpatient appointments and associated costs attributable to RSV; (Secondary outcomes) All-cause general practice consultations and associated costs attributable to RSV; Cardiorespiratory general practice consultations and associated costs attributable to RSV; Respiratory A&E attendances and associated costs attributable to RSV; Cardiorespiratory hospital admissions and associated costs attributable to RSV. Study 3: (Primary outcomes) Respiratory primary care antibiotic prescriptions attributable to RSV; Respiratory general practice consultations and associated costs attributable to RSV; All-cause A&E attendances and associated costs attributable to RSV; Respiratory hospital admissions and associated costs attributable to RSV; All-cause outpatient appointments and associated costs attributable to RSV.
Application Number: 
20_000283
Collaborators: 

Ceire Costelloe - Chief Investigator - Imperial College London
Lucy Miller - Corresponding Applicant - Imperial College London
Julie Robotham - Collaborator - Public Health England
Koen Pouwels - Collaborator - University of Oxford
Thomas Beaney - Collaborator - Imperial College London

Linkages: 
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Practice Level Index of Multiple Deprivation