The cost impact of PCT-guided antibiotic stewardship versus usual care for hospitalised patients with suspected sepsis or lower respiratory tract infections in the US: A health economic model analysis
The cost impact of PCT-guided antibiotic stewardship versus usual care for hospitalised patients with suspected sepsis or lower respiratory tract infections in the US: A health economic model analysis
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DOI：
10.1371/journal.pone.0214222
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发表时间：
2019-04-23
期刊：
影响因子：
3.7
通讯作者：
Steuten, Lotte M.
中科院分区：
文献类型：
--
作者：
Mewes, Janne C.;Pulia, Michael S.;Steuten, Lotte M.
背景降钙素原是一种生物标志物，可为临床决定何时开始和停止抗生素治疗提供依据。几个成本对降钙素原指导的抗生素管理进行了（-有效性）分析，但没有一个主要基于美国的数据。目的比较降钙素原的有效性和成本，算法与标准护理，以指导抗生素处方的患者住院诊断疑似败血症或下呼吸道感染在美国。降钙素原指导护理的成本和效果。该分析考虑了社会和医院的角度，时间范围涵盖住院时间。主要结果是每位患者的总成本，包括治疗成本和生产力损失，抗生素耐药或C。difficile感染，和成本每抗生素day avoided. ResultsProcalcitonin指导的护理住院患者疑似败血症和下呼吸道感染与减少抗生素天，在常规病房和重症监护室的停留时间较短，机械通气的持续时间较短，更少的患者在抗生素耐药或C。艰难感染与标准治疗相比，降钙素原组的总成本在脓毒症和下呼吸道感染中分别降低了26.0%和17.7（每名患者的总增量成本为-11，311美元，结论：使用降钙素原算法指导败血症和住院下呼吸道感染患者的抗生素使用，预计将产生成本-节省了医院的费用，降低了抗生素耐药性和C.艰难感染。
BackgroundProcalcitonin is a biomarker that supports clinical decision-making on when to initiate and discontinue antibiotic therapy. Several cost (-effectiveness) analyses have been conducted on Procalcitonin-guided antibiotic stewardship, but none mainly based on US originated data.ObjectiveTo compare effectiveness and costs of a Procalcitonin-algorithm versus standard care to guide antibiotic prescription for patients hospitalized with a diagnosis of suspected sepsis or lower respiratory tract infection in the US.MethodsA previously published health economic decision model was used to compare the costs and effects of Procalcitonin-guided care. The analysis considered the societal and hospital perspective with a time horizon covering the length of hospital stay. The main outcomes were total costs per patient, including treatment costs and productivity losses, the number of patients with antibiotic resistance or C. difficile infections, and costs per antibiotic day avoided.ResultsProcalcitonin-guided care for hospitalized patients with suspected sepsis and lower respiratory tract infection is associated with a reduction in antibiotic days, a shorter length of stay on the regular ward and the intensive care unit, shorter duration of mechanical ventilation, and fewer patients at risk for antibiotic resistant or C. difficile infection. Total costs in the Procalcitonin-group compared to standard care were reduced by 26.0% in sepsis and 17.7% in lower respiratory tract infection (total incremental costs of -$11,311 per patient and -$2,867 per patient respectively).ConclusionsUsing a Procalcitonin-algorithm to guide antibiotic use in sepsis and hospitalised lower respiratory tract infection patients is expected to generate cost-savings to the hospital and lower rates of antibiotic resistance and C. difficile infections.