Procalcitonin-Guided Antimicrobial Stewardship for Sepsis and Lower Respiratory Tract Infections: A Budget Impact Analysis for the Perspective of the Patients in India
Author(s)
Eesha Angadi, MD1, Osvaldo Ulises Garay, MSc2, Justin Aryabhat Gopaldas, MD3, Deven Juneja, DNB4, Kishore Mangal, MD5, Yashesh Paliwal, MD6, Subramanian Swaminathan, MD7, Niraj Tyagi, MD8.
1Roche Diagnostics India Pvt Ltd, Mumbai, India, 2Roche Diagnostics International, Rotkreuz, Switzerland, 3Manipal Hospital, Jayanagar, Bangalore, India, 4Max Super Speciality Hospital, Saket, New Delhi, India, 5Fortis Hospital, Jaipur, India, 6Fortis Hospital, Anandapur, Kolkata, India, 7Gleneagles Hospitals, Chennai, India, 8Sir Ganga Ram Hospital, New Delhi, India.
1Roche Diagnostics India Pvt Ltd, Mumbai, India, 2Roche Diagnostics International, Rotkreuz, Switzerland, 3Manipal Hospital, Jayanagar, Bangalore, India, 4Max Super Speciality Hospital, Saket, New Delhi, India, 5Fortis Hospital, Jaipur, India, 6Fortis Hospital, Anandapur, Kolkata, India, 7Gleneagles Hospitals, Chennai, India, 8Sir Ganga Ram Hospital, New Delhi, India.
OBJECTIVES: In India, the majority of acute care is delivered by private healthcare providers and out-of-pocket costs pose a concern. Antimicrobial overuse in sepsis and lower respiratory tract infections (LRTIs), has severe clinical and economic consequences for patients and health systems. Despite evidence supporting procalcitonin (PCT)-guided algorithms in reducing antibiotic duration, their financial impact on patients remains unclear. This study aimed to evaluate the clinical outcomes and economic implications for patients in India implementing PCT-guided antibiotic therapy.
METHODS: We adapted a previously developed decision tree model to explore clinical and economic implications in Indian patients with suspected sepsis and LRTI in the intensive care unit and hospitalized in general wards. Model inputs were derived from a targeted literature review of local and international data, validated by a panel of Indian clinical experts. Key outcomes included annual total antibiotic treatment days, antibiotic-resistant cases, and patient-specific costs. To address parameter uncertainty, deterministic, probabilistic, and multiple scenario analyses were conducted.
RESULTS: Analysis estimates that using procalcitonin-guided algorithms would result in 49.02 million and 1.09 million fewer antibiotic treatment days and antibiotic-resistant cases per year respectively. The economic impact for patients was estimated at ₹-12,487.5, per Sepsis patient and at ₹-10,584.5 per patient with LRTI. Sensitivity analyses confirmed the robustness of these findings, with the most influential variables being the reduction in antibiotic use attributable to PCT, the number of PCT tests performed, and the daily cost of antibiotic therapy.
CONCLUSIONS: These findings suggest that integrating PCT-guided algorithms in resource-limited settings like India offers significant benefits, including reduced antibiotic resistance, and substantial cost savings for patients within the Indian healthcare system. This approach supports antimicrobial stewardship and aligns with efforts to optimize resource utilization, warranting further consideration for widespread adoption in resource-constrained settings.
METHODS: We adapted a previously developed decision tree model to explore clinical and economic implications in Indian patients with suspected sepsis and LRTI in the intensive care unit and hospitalized in general wards. Model inputs were derived from a targeted literature review of local and international data, validated by a panel of Indian clinical experts. Key outcomes included annual total antibiotic treatment days, antibiotic-resistant cases, and patient-specific costs. To address parameter uncertainty, deterministic, probabilistic, and multiple scenario analyses were conducted.
RESULTS: Analysis estimates that using procalcitonin-guided algorithms would result in 49.02 million and 1.09 million fewer antibiotic treatment days and antibiotic-resistant cases per year respectively. The economic impact for patients was estimated at ₹-12,487.5, per Sepsis patient and at ₹-10,584.5 per patient with LRTI. Sensitivity analyses confirmed the robustness of these findings, with the most influential variables being the reduction in antibiotic use attributable to PCT, the number of PCT tests performed, and the daily cost of antibiotic therapy.
CONCLUSIONS: These findings suggest that integrating PCT-guided algorithms in resource-limited settings like India offers significant benefits, including reduced antibiotic resistance, and substantial cost savings for patients within the Indian healthcare system. This approach supports antimicrobial stewardship and aligns with efforts to optimize resource utilization, warranting further consideration for widespread adoption in resource-constrained settings.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE617
Topic
Economic Evaluation, Medical Technologies
Topic Subcategory
Budget Impact Analysis
Disease
Infectious Disease (non-vaccine)