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Is Procalcitonin-Guided Antimicrobial Use Cost-Effective in Adult Patients with Suspected Bacterial Infection and Sepsis?

Published online by Cambridge University Press:  05 January 2015

Michelle Harrison  and
Curtis D. Collins
Michelle Harrison
Affiliation:
Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, Michigan.
Curtis D. Collins*
Affiliation:
Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, Michigan.
*
Address correspondence to Curtis Collins, PharmD, MS, BCPS AQ-ID, FASHP, St. Joseph Mercy Health System, 5301 East Huron River Dr., Ann Arbor, Michigan 48106, USA (cdc008@yahoo.com).
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Abstract

OBJECTIVE

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.

DESIGN

Cost-minimization and cost-utility analysis.

PATIENTS

Hypothetical cohort of adult ICU patients with suspected bacterial infection and sepsis.

METHODS

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.

RESULTS

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 (<42.3%), number and cost of procalcitonin tests ordered (≥9 and >$46), days of antimicrobial reduction (<1.6 d), incidence of nephrotoxicity and rate of nephrotoxicity reduction.

CONCLUSION

The combination of procalcitonin testing with an evidence-based treatment algorithm may improve patients’ quality of life while decreasing costs in ICU patients with suspected bacterial infection and sepsis; however, results were highly dependent on a number of variables and assumptions.

Infect Control Hosp Epidemiol 2014;00(0): 1–8

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 3 , March 2015 , pp. 265 - 272
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

DISCLOSURE. An earlier version of this manuscript was presented at ID Week 2014

References

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