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Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Publication date 2015
Author Schuetz Philipp, Balk Robert, Briel Matthias, Kutz Alexander, Christ-Crain Mirjam, Stolz Daiana, Bouadma Lila, Wolff Michel, Kristoffersen Kristina B, Wei Long, Burkhardt Olaf, Welte Tobias, Schroeder Stefan, Nobre Vandack, Tamm Michael, Bhatnagar Neera, Bucher Heiner C, Luyt Charles-Edouard, Chastre Jean, Tubach Florence, Mueller Beat, Lacey Michael J, Ohsfeldt Robert L, Scheibling Cara M, Schneider John E,
Project The vicious-cycle of acute exacerbation in chronic obstructive pulmonary disease: orchestration of infection, systemic inflammatory response and airway remodelling
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Original article (peer-reviewed)

Journal Clinical chemistry and laboratory medicine
Volume (Issue) 53(4)
Page(s) 583 - 92
Title of proceedings Clinical chemistry and laboratory medicine
DOI 10.1515/cclm-2014-1015

Abstract

Whether or not antibiotic stewardship protocols based on procalcitonin levels results in cost savings remains unclear. Herein, our objective was to assess the economic impact of adopting procalcitonin testing among patients with suspected acute respiratory tract infection (ARI) from the perspective of a typical US integrated delivery network (IDN) with a 1,000,000 member catchment area or enrollment. To conduct an economic evaluation of procalcitonin testing versus usual care we built a cost-impact model based on patient-level meta-analysis data of randomized trials. The meta-analytic data was adapted to the US setting by applying the meta-analytic results to US lengths of stay, costs, and practice patterns. We estimated the annual ARI visit rate for the one million member cohort, by setting (inpatient, ICU, outpatient) and ARI diagnosis. In the inpatient setting, the costs of procalcitonin-guided compared to usual care for the one million member cohort was $2,083,545, compared to $2,780,322, resulting in net savings of nearly $700,000 to the IDN for 2014. In the ICU and outpatient settings, savings were $73,326 and $5,329,824, respectively, summing up to overall net savings of $6,099,927 for the cohort. RESULTS were robust for all ARI diagnoses. For the whole US insured population, procalcitonin-guided care would result in $1.6 billion in savings annually. Our results show substantial savings associated with procalcitonin protocols of ARI across common US treatment settings mainly by direct reduction in unnecessary antibiotic utilization. These results are robust to changes in key parameters, and the savings can be achieved without any negative impact on treatment outcomes.
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