175Cost-effectiveness of a Procalcitonin-Guided Treatment Algorithm in Sepsis
نویسندگان
چکیده
Background. 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. Procalcitonin testing, however, is an additional expenditure which may or may not be offset by treatment-related financial gains. The cost-effectiveness of procalcitonin use has not been established in patients with sepsis. The objective of this study was to determine the cost-effectiveness of utilizing a procalcitonin algorithm to guide patient care compared with standard care in patients with sepsis. Methods. A decision analytic model was developed from a hospital perspective. Published clinical and economic data populated a cost-minimization and a cost-utility analysis across 10,000 hypothetical patient scenarios. Univariate and probabilistic sensitivity analyses assessed the robustness of our model across all likely scenarios. Results. Our model predicted that the use of a procalcitonin algorithm dominated standard care (i.e., increased effectiveness with decreased costs). The incremental cost of procalcitonin use vs standard care saved $168 per septic episode while increasing a patients’ quality of life. Secondary analyses found variables which had the potential to alter results included: compliance with algorithm adherence (<25.2%), days of antibiotic reduction (<0.28), the probability of antimicrobial-induced nephrotoxicity (<11%), or decreased nephrotoxicity through antimicrobial reduction (<0.9%). Under these circumstances, our model predicted a higher incremental cost of procalcitonin use; however, procalcitonin use remained cost-effective at our predetermined willingness-to-pay threshold. Conclusion. Our model predicts that use of a procalcitonin-guided treatment algorithm in sepsis patients may be cost-effective. Implementing a procalcitonin-guided treatment algorithm in septic patients could improve the quality of care and decrease costs in patients with sepsis. Disclosures. All authors: No reported disclosures.
منابع مشابه
Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock – a systematic review and meta-analysis
INTRODUCTION Procalcitonin (PCT) algorithms for antibiotic treatment decisions have been studied in adult patients from primary care, emergency department, and intensive care unit (ICU) settings, suggesting that procalcitonin-guided therapy may reduce antibiotic exposure without increasing the mortality rate. However, information on the efficacy and safety of this approach in the most vulnerabl...
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