Is procalcitonin-guided antimicrobial use cost-effective in adult patients with suspected bacterial infection and sepsis?

• Published in: Infection control and hospital epidemiology 2015-03, Vol.36 (3), p.265-272
• Main Authors: Harrison, Michelle, Collins, Curtis D
• Format: Article
• Language: English
• Subjects: Adult; Algorithms; Anti-Bacterial Agents - economics; Anti-Bacterial Agents - therapeutic use; Antimicrobial agents; Bacterial diseases; Bacterial infections; Bacterial Infections - blood; Bacterial Infections - diagnosis; Bacterial Infections - drug therapy; Bacterial Infections - economics; Biomarkers - blood; Calcitonin - blood; Calcitonin Gene-Related Peptide; Clinical Decision-Making; Cost analysis; Cost-Benefit Analysis; Creatinine; Distribution costs; Health care expenditures; Hospital Costs - statistics & numerical data; Hospitalization; Humans; Intensive care; Length of stay; Models, Economic; Mortality; Protein Precursors - blood; Quality of life; Quality-Adjusted Life Years; Sensitivity analysis; Sepsis; Sepsis - blood; Sepsis - diagnosis; Sepsis - drug therapy; Sepsis - economics; Staphylococcus infections; Thyroid gland; United States; Variables
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2014.60

Procalcitonin has emerged as a promising biomarker of bacterial infection. Published literature demonstrates that use of procalcitonin testing and an associated treatment pathway reduces duration of antibiotic therapy without impacting mortality. The objective of this study was to determine the financial impact of utilizing a procalcitonin-guided treatment algorithm in hospitalized patients with sepsis. Cost-minimization and cost-utility analysis. Hypothetical cohort of adult ICU patients with suspected bacterial infection and sepsis. Utilizing published clinical and economic data, a decision analytic model was developed from the U.S. hospital perspective. Effectiveness and utility measures were defined using cost-per-clinical episode and cost per quality-adjusted life years (QALYs). Upper and lower sensitivity ranges were determined for all inputs. Univariate and probabilistic sensitivity analyses assessed the robustness of our model and variables. Incremental cost-effectiveness ratios (ICERs) were calculated and compared to predetermined willingness-to-pay thresholds. Base-case results predicted the use of a procalcitonin-guided treatment algorithm dominated standard care with improved quality (0.0002 QALYs) and decreased overall treatment costs ($65). The model was sensitive to a number of key variables that had the potential to impact results, including algorithm adherence ($46), days of antimicrobial reduction (