Suspected acute respiratory infection in over 16s: assessment at first presentation and initial management

Resource impact statement

The NICE guideline on suspected acute respiratory infection (ARI) in over 16s will help healthcare practitioners with the initial management of people aged 16 and over with symptoms and signs of an ARI when they first present to NHS services. The guideline covers remote and in person contact and is intended to support healthcare practitioners in making sure that people are on the best care pathway. This includes options to refer to virtual wards and ARI hubs.

We expect that the resource impact of this update:

• for any single guideline recommendation in England will be less than £1 million per year (or approximately £1,800 per 100,000 population, based on a population for England of 56.6 million people) and
• for implementing the whole guideline in England will be less than £5 million per year (or approximately £8,800 per 100,000 population, based on a population for England of 56.6 million people).

These recommendations will help healthcare practitioners recognise bacterial pneumonia and should improve antimicrobial stewardship by reducing the number of inappropriate antibiotics prescribed for people with ARI. This has the potential to create savings. It is estimated that savings could range from around £2 to £19 for each person that is assessed and does not require antibiotics (sourced from NHS Electronic Drug Tariff accessed in July 2023).

Recommendation 1.3.4 says that point of care C-reactive protein (CRP) tests should be considered to support clinical decision making if, after clinical assessment, it is unclear whether antibiotics are needed for someone with a lower respiratory tract infection.  Recommendations around CRP testing have previously been made in NICE's guideline on pneumonia, but we understand that the practice hasn’t been universally adopted. Adhering to this guidance will therefore impact users who do not currently use CRP tests under these circumstances.

ARI services are commissioned by integrated care boards. Providers are community providers and GP practices.