Cost impact of procalcitonin-guided decision making on duration of antibiotic therapy for suspected early-onset sepsis in neonates.

Autor: Geraerds AJLM; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. a.geraerds@erasmusmc.nl., van Herk W; Division of Paediatric Infectious Diseases & Immunology, Department of Paediatrics, Erasmus MC University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands., Stocker M; Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland., El Helou S; Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada., Dutta S; Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada., Fontana MS; Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland., Schuerman FABA; Neonatal Intensive Care Unit, Isala Women and Children's Centre, Isala Hospital, Zwolle, The Netherlands., van den Tooren-de Groot RK; Department of Paediatrics, Haaglanden Medical Center, 's Gravenhage, The Netherlands., Wieringa J; Department of Paediatrics, Haaglanden Medical Center, 's Gravenhage, The Netherlands., Janota J; Neonatal Unit, Department of Obstetrics and Gynaecology, Motol University Hospital, Second Medical Faculty, Charles University, Prague, Czech Republic.; Institute of Pathological Physiology, First Medical Faculty, Charles University, Prague, Czech Republic., van der Meer-Kappelle LH; Department of Neonatology, Reinier de Graaf Gasthuis, Delft, The Netherlands., Moonen R; Department of Neonatology, Zuyderland Medical Centre, Heerlen, The Netherlands., Sie SD; Department of Neonatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., de Vries E; Department of Paediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands., Donker AE; Department of Paediatrics, Maxima Medical Centre, Veldhoven, The Netherlands., Zimmerman U; Department of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland., Schlapbach LJ; Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.; Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia., de Mol AC; Department of Neonatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands., Hoffman-Haringsma A; Department of Neonatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands., Roy M; Department of Neonatology, St. Josephs Healthcare, Hamilton Health Sciences, Hamilton, ON, Canada., Tomaske M; Department of Paediatrics, Stadtspital Triemli, Zürich, Switzerland., Kornelisse RF; Division of Neonatology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands., van Gijsel J; Julius Training General Practitioner, University Medical Centre Utrecht, Utrecht, The Netherlands., Visser EG; Division of Paediatric Infectious Diseases & Immunology, Department of Paediatrics, Erasmus MC University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands., van Rossum AMC; Division of Paediatric Infectious Diseases & Immunology, Department of Paediatrics, Erasmus MC University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands., Polinder S; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2021 Oct 20; Vol. 25 (1), pp. 367. Date of Electronic Publication: 2021 Oct 20.
DOI: 10.1186/s13054-021-03789-x
Abstrakt: Backgrounds: The large, international, randomized controlled NeoPInS trial showed that procalcitonin (PCT)-guided decision making was superior to standard care in reducing the duration of antibiotic therapy and hospitalization in neonates suspected of early-onset sepsis (EOS), without increased adverse events. This study aimed to perform a cost-minimization study of the NeoPInS trial, comparing health care costs of standard care and PCT-guided decision making based on the NeoPInS algorithm, and to analyze subgroups based on country, risk category and gestational age.
Methods: Data from the NeoPInS trial in neonates born after 34 weeks of gestational age with suspected EOS in the first 72 h of life requiring antibiotic therapy were used. We performed a cost-minimization study of health care costs, comparing standard care to PCT-guided decision making.
Results: In total, 1489 neonates were included in the study, of which 754 were treated according to PCT-guided decision making and 735 received standard care. Mean health care costs of PCT-guided decision making were not significantly different from costs of standard care (€3649 vs. €3616). Considering subgroups, we found a significant reduction in health care costs of PCT-guided decision making for risk category 'infection unlikely' and for gestational age ≥ 37 weeks in the Netherlands, Switzerland and the Czech Republic, and for gestational age < 37 weeks in the Czech Republic.
Conclusions: Health care costs of PCT-guided decision making of term and late-preterm neonates with suspected EOS are not significantly different from costs of standard care. Significant cost reduction was found for risk category 'infection unlikely,' and is affected by both the price of PCT-testing and (prolonged) hospitalization due to SAEs.
(© 2021. The Author(s).)
Databáze: MEDLINE
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