Cost-effectiveness of procalcitonin testing to guide antibiotic treatment duration in critically ill patients: results from a randomised controlled multicentre trial in the Netherlands

Michelle M. A. Kip*, Jos A. van Oers, Arezoo Shajiei, Albertus Beishuizen, A. M. Sofie Berghuis, Armand R. Girbes, Evelien de Jong, Dylan W. de Lange, Maarten W. N. Nijsten, Maarten J. IJzerman, Hendrik Koffijberg, Ron Kusters

*Corresponding author for this work

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Abstract

BackgroundProcalcitonin (PCT) testing can help in safely reducing antibiotic treatment duration in intensive care patients with sepsis. However, the cost-effectiveness of such PCT guidance is not yet known.MethodsA trial-based analysis was performed to estimate the cost-effectiveness of PCT guidance compared with standard of care (without PCT guidance). Patient-level data were used from the SAPS trial in which 1546 patients were randomised. This trial was performed in the Netherlands, which is a country with, on average, low antibiotic use and a short duration of hospital stay. As quality of life among sepsis survivors was not measured during the SAPS, this was derived from a Dutch follow-up study. Outcome measures were (1) incremental direct hospital cost and (2) incremental cost per quality-adjusted life year (QALY) gained from a healthcare perspective over a one-year time horizon. Uncertainty in outcomes was assessed with bootstrapping.ResultsMean in-hospital costs were Euro46,081/patient in the PCT group compared with Euro46,146/patient with standard of care (i.e. -Euro65 (95% CI -Euro6314 to Euro6107); -0.1%). The duration of the first course of antibiotic treatment was lower in the PCT group with 6.9 vs. 8.2days (i.e. -1.2days (95% CI -1.9 to -0.4), -14.8%). This was accompanied by lower in-hospital mortality of 21.8% vs. 29.8% (absolute decrease 7.9% (95% CI -13.9% to -1.8%), relative decrease 26.6%), resulting in an increase in mean QALYs/patient from 0.47 to 0.52 (i.e.+0.05 (95% CI 0.00 to 0.10); +10.1%). However, owing to high costs among sepsis survivors, healthcare costs over a one-year time horizon were Euro73,665/patient in the PCT group compared with Euro70,961/patient with standard of care (i.e.+Euro2704 (95% CI -Euro4495 to Euro10,005), +3.8%), resulting in an incremental cost-effectiveness ratio of Euro57,402/QALY gained. Within this time frame, the probability of PCT guidance being cost-effective was 64% at a willingness-to-pay threshold of Euro80,000/QALY.ConclusionsAlthough the impact of PCT guidance on total healthcare-related costs during the initial hospitalisation episode is likely negligible, the lower in-hospital mortality may lead to a non-significant increase in costs over a one-year time horizon. However, since uncertainty remains, it is recommended to investigate the long-term cost-effectiveness of PCT guidance, from a societal perspective, in different countries and settings.

Original languageEnglish
Article number293
Number of pages10
JournalCritical Care
Volume22
DOIs
Publication statusPublished - 13-Nov-2018

Keywords

  • Cost-effectiveness
  • Intensive care
  • Procalcitonin
  • Sepsis
  • INTENSIVE-CARE PATIENTS
  • SEPTIC PATIENTS
  • BACTERIAL-INFECTION
  • PCT-ALGORITHM
  • SEVERE SEPSIS
  • IMPUTATION
  • EXPOSURE
  • THERAPY
  • IMPACT

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