Cisco Giulio, Meier Armando N, Senn Nicolas, Mueller Yolanda, Kronenberg Andreas, Locatelli Isabella, Knüsli José, Lhopitallier Loïc, Boillat-Blanco Noemie, Marti Joachim
Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Eur J Health Econ. 2025 Feb;26(1):129-139. doi: 10.1007/s10198-024-01694-y. Epub 2024 May 18.
Antimicrobial resistance comes with high morbidity and mortality burden, and ultimately high impact on healthcare and social costs. Efficient strategies are needed to limit antibiotic overuse. This paper investigates the cost-effectiveness of testing patients with lower respiratory tract infection with procalcitonin, either at the point-of-care only or combined with lung ultrasonography. These diagnostic tools help detect the presence of bacterial pneumonia, guiding prescription decisions. The clinical responses of these strategies were studied in the primary care setting. Evidence is needed on their cost-effectiveness. We used data from a cluster-randomized bi-centric clinical trial conducted in Switzerland and estimated patient-level costs using data on resource use to which we applied Swiss tariffs. Combining the incremental costs of the two strategies and the reduction in the 28-days antibiotic prescription rate (APR) compared to usual care, we calculated Incremental Cost-Effectiveness Ratios (ICER). We also used the Cost-Effectiveness Acceptability Curve as an analytical decision-making tool. The robustness of the findings is ensured by Probabilistic Sensitivity Analysis and scenario analysis. In the base case scenario, the ICER compared to usual care is $2.3 per percentage point (pp) reduction in APR for the procalcitonin group, and $4.4 for procalcitonin-ultrasound combined. Furthermore, we found that for a willingness to pay per patient of more than $2 per pp reduction in the APR, procalcitonin is the strategy with the highest probability to be cost-effective. Our findings suggest that testing patients with respiratory symptoms with procalcitonin to guide antibiotic prescription in the primary care setting represents good value for money.
抗菌药物耐药性带来了高昂的发病和死亡负担，最终对医疗保健和社会成本产生重大影响。需要有效的策略来限制抗生素的过度使用。本文研究了仅在即时护理点或结合肺部超声检查使用降钙素原检测下呼吸道感染患者的成本效益。这些诊断工具有助于检测细菌性肺炎的存在，指导处方决策。在初级保健环境中研究了这些策略的临床反应。需要有关其成本效益的证据。我们使用了在瑞士进行的一项整群随机双中心临床试验的数据，并利用资源使用数据（应用瑞士关税）估算患者层面的成本。结合两种策略的增量成本以及与常规护理相比28天抗生素处方率（APR）的降低情况，我们计算了增量成本效益比（ICER）。我们还使用成本效益可接受性曲线作为分析决策工具。通过概率敏感性分析和情景分析确保了研究结果的稳健性。在基础情景中，与常规护理相比，降钙素原组每降低1个百分点APR的ICER为2.3美元，降钙素原 - 超声联合组为4.4美元。此外，我们发现，对于每位患者每降低1个百分点APR愿意支付超过2美元的情况，降钙素原是最有可能具有成本效益的策略。我们的研究结果表明，在初级保健环境中使用降钙素原检测有呼吸道症状的患者以指导抗生素处方具有良好的性价比。
