Cost-effectiveness of procalcitonin-guided antibiotic use in community acquired pneumonia

Kenneth J Smith, Angela Wateska, M Patricia Nowalk, Mahlon Raymund, Bruce Y Lee, Richard K Zimmerman, Michael J Fine
Journal of General Internal Medicine 2013, 28 (9): 1157-64

BACKGROUND: Although prior randomized trials have demonstrated that procalcitonin-guided antibiotic therapy effectively reduces antibiotic use in patients with community-acquired pneumonia (CAP), uncertainties remain regarding use of procalcitonin protocols in practice.

OBJECTIVE: To estimate the cost-effectiveness of procalcitonin protocols in CAP.

DESIGN: Decision analysis using published observational and clinical trial data, with variation of all parameter values in sensitivity analyses.

PATIENTS: Hypothetical patient cohorts who were hospitalized for CAP.

INTERVENTIONS: Procalcitonin protocols vs. usual care.

MAIN MEASURES: Costs and cost per quality adjusted life year gained.

KEY RESULTS: When no differences in clinical outcomes were assumed, consistent with clinical trials and observational data, procalcitonin protocols cost $10-$54 more per patient than usual care in CAP patients. Under these assumptions, results were most sensitive to variations in: antibiotic cost, the likelihood that antibiotic therapy was initiated less frequently or over shorter durations, and the likelihood that physicians were nonadherent to procalcitonin protocols. Probabilistic sensitivity analyses, incorporating procalcitonin protocol-related changes in quality of life, found that protocol use was unlikely to be economically reasonable if physician protocol nonadherence was high, as observational study data suggest. However, procalcitonin protocols were favored if they decreased hospital length of stay.

CONCLUSIONS: Procalcitonin protocol use in hospitalized CAP patients, although promising, lacks physician nonadherence and resource use data in routine care settings, which are needed to evaluate its potential role in patient care.


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