Department of Pharmacy Practice, College of Pharmacy, Arab Academy for Science, Technology & Maritime Transport (AASTMT), Alexandria, Egypt.
Department of Biomedical informatics and medical statistics - Medical Research Institute (MRI), Alexandria University - Alexandria, Alexandria, Egypt.
BMC Health Serv Res. 2024 Oct 17;24(1):1249. doi: 10.1186/s12913-024-11675-9.
Sepsis, which is described as a life-threatening organ malfunction brought on by an unbalanced host response to infection, continues to be a significant healthcare issue that affects millions of individuals each year. It is well-known that sepsis can affect anyone around the world, but the employed survey results showed that there are significant regional variations in sepsis incidence as well as mortality rates. Although there are no definite estimates for Egypt, the highest rates were in Low-Middle-Income Countries (LMICs). Procalcitonin (PCT) is a host response marker with high specificity for bacterial infections, unlike C-reactive protein (CRP) or white blood cell count (WBC), which represent the traditional methods of detecting inflammation and infection. Its dynamic profile and superior prognostic prediction make it invaluable for assessing response to antibiotic treatment and improving clinical care for sepsis patients. Our main purpose was to evaluate the cost-effectiveness of PCT guidance compared to no PCT guidance in the antibiotic management of adult sepsis patients according to the Egyptian context.
We developed a decision tree model to compare the PCT-guided antibiotic management duration endpoint versus the conventional laboratory culture-based antibiotic management in adult sepsis patients. We employed the"Delphi technique" to reach a satisfactory consensus regarding the resources attributed to each compared alternative. The primary measure of the study was the additional cost associated with each Quality-Adjusted Life Year (QALY) gained by sepsis survivors over a one-year time horizon. Base-case, deterministic and probabilistic sensitivity analyses were conducted using TreeAge, Software.
Base-case analysis showed no dominance for either alternative and resulted in an Incremental Cost-Effectiveness Ratio (ICER) value of 297,783.57 Egyptian Pounds per Quality Adjusted Life Year (L.E/QALY) in favor of the PCT guidance alternative, Deterministic sensitivity analysis revealed that the highest impact magnitudes on ICER reside with seven input parameters, the top two parameters that had the most significant influence were the costs of ICU stay with and without PCT guidance. The CEAC showed a slightly higher probability in terms of acceptability in favor of the no PCT guidance choice along the WTP scale till reaching equal probabilities at the willingness-to-pay (WTP) value point of 390,000 (state currency) after which the - probability supports the PCT guidance choice.
In the Egyptian context, PCT guidance has no cost-effectiveness domination over no PCT guidance in Antibiotics management for adult sepsis patients. This may be attributed to the high cost of PCT investigation that shall be resolved by standardization of its cost when applying the approach of DRG cost packages.
败血症是一种由宿主对感染的失衡反应引起的危及生命的器官功能障碍，它仍然是一个严重的医疗保健问题，每年影响着数百万人。众所周知，败血症可能影响全球任何人，但调查结果显示，败血症的发病率和死亡率存在显著的地区差异。虽然埃及没有确切的估计，但发病率最高的是中低收入国家（LMICs）。降钙素原（PCT）是一种宿主反应标志物，与 C 反应蛋白（CRP）或白细胞计数（WBC）不同，它对细菌感染具有高度特异性，而 CRP 或白细胞计数代表传统的炎症和感染检测方法。其动态特征和优越的预后预测使其在评估败血症患者对抗生素治疗的反应和改善临床护理方面具有不可估量的价值。我们的主要目的是根据埃及的情况，评估 PCT 指导与无 PCT 指导在成人败血症患者抗生素管理中的成本效益。
我们开发了一个决策树模型，比较了 PCT 指导的抗生素管理持续时间终点与成人败血症患者基于传统实验室培养的抗生素管理。我们采用“德尔菲技术”，就每个比较替代方案所涉及的资源达成了满意的共识。该研究的主要衡量标准是败血症幸存者在一年时间内获得的每个质量调整生命年（QALY）相关的额外成本。使用 TreeAge 软件进行基础案例、确定性和概率敏感性分析。
基础案例分析表明，两种方案均不占优势，导致 PCT 指导方案的增量成本效果比（ICER）值为 297783.57 埃及镑/质量调整生命年（L.E/QALY），有利于 PCT 指导方案。确定性敏感性分析表明，对 ICER 影响最大的幅度与七个输入参数有关，对 ICER 影响最大的两个参数是有和没有 PCT 指导的 ICU 住院费用。CEAC 显示在 WTP 范围内，沿着支付意愿（WTP）尺度，无 PCT 指导的选择更有可能被接受，直到在 390000 （本国货币）的 WTP 价值点达到相同的概率，之后，PCT 指导的选择支持概率。
在埃及的背景下，PCT 指导在成人败血症患者的抗生素管理中没有优于无 PCT 指导的成本效益。这可能归因于 PCT 检查的高成本，当应用 DRG 成本包方法时，应通过标准化其成本来解决。
