OBJECTIVES: In Belgium, antibiotic resistance leads to approximately 530 deaths with a €24 million financial burden annually. This study estimated the impact of procalcitonin-guided antibiotic stewardship to reduce antibiotic consumption versus standard of care in patients with suspected sepsis.

METHODS: A decision analytic tree modelled health and budget outcomes of procalcitonin-guided antibiotic stewardship programs for patients with suspected sepsis. A literature search, an expert survey with local clinical experts, and national database searches were conducted to obtain model input parameters. Main outcomes were total budget impact per patient, reduction in number of antibiotic resistance cases, and cost per antibiotic day avoided. To evaluate the impact of parameter uncertainty on the source data, a deterministic sensitivity analysis was performed. A scenario analysis was conducted to investigate budget impact when including parameters for reduction in length of stay in the intensive care unit and mechanical ventilation duration, in addition to base-case parameters.

RESULTS: Based on model predictions, procalcitonin-guided antibiotic stewardship could reduce the number of antibiotic days by 66,868, resulting in €1.98 million savings towards antibiotic treatment. Antibiotic resistance cases could decrease by 7.7% (6.1% vs 9.2%) in the procalcitonin-guided setting compared with standard of care setting. The base-case budget impact suggests an investment of €1.90 per patient. The sensitivity analysis showed uncertainty, as the main drivers can alter potential cost savings. The scenario analysis indicated a saving of €1,405 per patient, with a reduction of 1.5 days in the intensive care unit (14.8 days vs 12.8 days), and a reduction of 22.7% (18.1–27.2%) in mechanical ventilation duration. The associated sensitivity analysis was shown to be robust in all parameters.

CONCLUSIONS: Procalcitonin-guided antibiotic stewardship programs are associated with clinical benefits that positively influence antimicrobial resistance in Belgium. A small investment per patient to implement procalcitonin testing may lead to substantial savings.