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

Schuetz, P. and Balk, R. and Briel, M. and Kutz, A. and Christ-Crain, M. and Stolz, D. and Bouadma, L. and Wolff, M. and Kristoffersen, K. B. and Wei, L. and Burkhardt, O. and Welte, T. and Schroeder, S. and Nobre, V. and Tamm, M. and Bhatnagar, N. and Bucher, H. C. and Luyt, C. E. and Chastre, J. and Tubach, F. and Mueller, B. and Lacey, M. J. and Ohsfeldt, R. L. and Scheibling, C. M. and Schneider, J. E.. (2015) Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective. Clinical Chemistry and Laboratory Medicine, 53 (4). pp. 583-592.

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Official URL: http://edoc.unibas.ch/56883/

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Abstract

Abstract Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Allgemeine innere Medizin AG > Argovia Professur für Medizin (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Allgemeine innere Medizin AG > Argovia Professur für Medizin (Müller)
UniBasel Contributors:Müller, Beat
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:De Gruyter
ISSN:1434-6621
e-ISSN:1437-4331
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:04 Dec 2017 10:49
Deposited On:04 Dec 2017 10:49

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