OBJECTIVES : Procalcitonin (PCT) is a biomarker that can distinguish bacterial from non-bacterial infections and hereby support clinical decision-making on antibiotic therapy initiation and discontinuation. Cost analyses on PCT-guided antibiotic stewardship using real-world US hospital data have not yet been performed. The objective was to conduct a model-based cost-effectiveness analysis of using a PCT-algorithm to guide antibiotic prescription for patients hospitalized with sepsis or lower respiratory tract infections (LRTI) versus standard of care in a US hospital setting.

METHODS : A cost-effectiveness analysis was conducted, comparing costs and effects of care among patients admitted to the Five Rivers Medical Center, Pocahontas (AR), US, with sepsis or LRTI before and after implementation of PCT-guided antibiotic stewardship. A previously published health economic model was populated with patient-level data collected in the four years before and the four years after implementation of the PCT-algorithm. Literature data was used for parameter inputs not captured in the patient-level data. The analyses were conducted from the societal and the hospital perspective on costs and effects. The time horizon covered the length of hospital stay. Main outcomes were total average costs per patient and numbers of patients with C. difficile and antibiotic resistant (ABR) infections. Sensitivity analyses were conducted.

RESULTS : PCT-guided care for hospitalized sepsis and LRTI patients resulted in a shorter length of stay, reduced antibiotic use and fewer mechanical ventilation days, and lower numbers of patients with C. difficile and ABR infections. Total incremental costs per patient for PCT-guided care were -$25,611 (-49%) for sepsis and -$3,630 (-23%) for LRTI, respectively, indicating cost-savings. Results were robust to changes in input parameters.

CONCLUSIONS : PCT-guided antibiotic stewardship for sepsis and LRTI patients is expected to save costs and to result in lower C. difficile and ABR infection rates, in comparison to standard of care, in a US hospital setting.