Panaxea B.V., Amsterdam, the Netherlands.
BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States of America.
PLoS One. 2019 Apr 23;14(4):e0214222. doi: 10.1371/journal.pone.0214222. eCollection 2019.
Procalcitonin 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.
To 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.
A 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.
Procalcitonin -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).
Using 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.
降钙素原是一种生物标志物，可辅助临床决策何时开始和停止抗生素治疗。已经针对降钙素原指导抗生素管理进行了多项成本（效益）分析，但没有一项主要基于源自美国的数据。
比较降钙素原算法与标准护理在指导疑似脓毒症或下呼吸道感染住院患者使用抗生素方面的有效性和成本。
使用先前发表的卫生经济决策模型来比较降钙素原指导护理的成本和效果。该分析从社会和医院角度考虑，时间范围涵盖住院时间。主要结果是每位患者的总费用，包括治疗费用和生产力损失、发生抗生素耐药或艰难梭菌感染的患者数量，以及避免使用抗生素的天数所产生的成本。
对疑似脓毒症和下呼吸道感染的住院患者进行降钙素原指导护理与减少抗生素天数、普通病房和重症监护病房的住院时间缩短、机械通气时间缩短以及发生抗生素耐药或艰难梭菌感染风险降低相关。与标准护理相比，降钙素原组在脓毒症患者中的总费用降低了 26.0%，在下呼吸道感染患者中的总费用降低了 17.7%（每位患者的总增量成本分别为-11311 美元和-2867 美元）。
使用降钙素原算法指导脓毒症和住院下呼吸道感染患者使用抗生素有望为医院节省成本，并降低抗生素耐药和艰难梭菌感染的发生率。
