A PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis

Objective:Procalcitonin (PCT) is a specific marker for differentiating bacterial from non-infective causes of inflammation. It can be used to guide initiation and duration of antibiotic therapy in intensive care unit (ICU) patients with suspected sepsis, and might reduce the duration of hospital stay. Limiting antibiotic treatment duration is highly important because antibiotic over-use may cause patient harm, prolonged hospital stay, and resistance development. Several systematic reviews show that a PCT algorithm for antibiotic discontinuation is safe, but upfront investment required for PCT remains an important barrier against implementation. The current study investigates to what extent this PCT algorithm is a cost-effective use of scarce healthcare resources in ICU patients with sepsis compared to current practice.Methods:A decision tree was developed to estimate the health economic consequences of the PCT algorithm for antibiotic discontinuation from a Dutch hospital perspective. Input data were obtained from a systematic literature review. When necessary, additional information was gathered from open interviews with clinical chemists and intensivists. The primary effectiveness measure is defined as the number of antibiotic days, and cost-effectiveness is expressed as incremental costs per antibiotic day avoided.Results:The PCT algorithm for antibiotic discontinuation is expected to reduce hospital spending by circa €3503 per patient, indicating savings of 9.2%. Savings are mainly due to reductions in length of hospital stay, number of blood cultures performed, and, importantly, days on antibiotic therapy. Probabilistic and one-way sensitivity analyses showed the model outcome to be robust against changes in model inputs.Conclusion:Proven safe, a PCT algorithm for antibiotic discontinuation is a cost-effective means of reducing antibiotic exposure in adult ICU patients with sepsis, compared to current practice. Additional resources required for PCT are more than offset by downstream cost savings. This finding is highly important given the aim of preventing widespread antibiotic resistance.

Objective: 降钙素原（Procalcitonin, PCT）是区分细菌性与非感染性炎症病因的特异性标志物。它可用于指导疑似脓毒症重症监护病房（Intensive Care Unit, ICU）患者的抗生素治疗启动与疗程，或可缩短住院时长。限制抗生素治疗疗程至关重要，因为抗生素滥用可能损害患者健康、延长住院时间并催生耐药性。多项系统综述显示，基于PCT的抗生素停药算法安全性良好，但PCT检测的前期投入仍是推广应用的重要障碍。本研究旨在对比当前临床实践，评估该PCT算法在脓毒症ICU患者中作为稀缺医疗资源使用的成本效益水平。
Methods: 本研究从荷兰医院的视角构建决策树模型，以估算基于PCT的抗生素停药算法带来的卫生经济学影响。输入数据来自系统文献综述，必要时通过与临床化学家及重症医师的开放式访谈补充相关信息。主要有效性指标定义为抗生素使用天数，成本效益以每避免1天抗生素治疗所需的增量成本表示。
Results: 结果显示，基于PCT的抗生素停药算法预计可使每位患者的住院花费减少约3503欧元，即节省9.2%的开支。节省的成本主要源于住院时长缩短、血培养检测次数减少，以及关键的抗生素治疗天数降低。概率敏感性分析与单因素敏感性分析结果表明，模型输出对输入参数的变化具有稳健性。
Conclusion: 研究证实，与当前临床实践相比，基于PCT的抗生素停药算法可安全降低成人脓毒症ICU患者的抗生素暴露量，是一种具备成本效益的手段。PCT检测所需的额外投入远低于后续节省的医疗成本。鉴于预防广谱抗生素耐药性的目标，这一发现具有重要意义。