The cost-effectiveness of procalcitonin for guiding antibiotic prescribing in individuals hospitalized with COVID-19: part of the PEACH study.

Autor:	Webb EJD; Leeds Institute for Health Sciences, University of Leeds, Leeds, UK., Howdon D; Leeds Institute for Health Sciences, University of Leeds, Leeds, UK., Bestwick R; Leeds Institute for Health Sciences, University of Leeds, Leeds, UK., King N; Leeds Institute for Health Sciences, University of Leeds, Leeds, UK., Sandoe JAT; Healthcare Associated Infection Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK.; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Euden J; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK., Grozeva D; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK., West R; Leeds Institute for Health Sciences, University of Leeds, Leeds, UK., Howard P; Healthcare Associated Infection Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK.; NHS England North-East & Yorkshire, Leeds, UK., Powell N; Pharmacy Department, Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Foundation Trust, Truro TR1 3LJ, UK., Albur M; Severn Infectious Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK., Bond S; Medicines Optimisation and Pharmacy Services, Pinderfields Hospital, Mid Yorkshire Teaching NHS Trust, Wakefield WF1 4DG, UK., Brookes-Howell L; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK., Dark P; Division of Immunology, Faculty of Biology, Medicine and Health, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester M13 9PL, UK., Hellyer T; Perioperative and Critical Care Department, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK.; Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK., Llewelyn M; Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PS, UK.; Department of Infection Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK., McCullagh IJ; Perioperative and Critical Care Department, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK.; Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK., Ogden M; Public and Patient Involvement Representative, NIHR, London SW1A 2NS, UK., Pallmann P; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK., Parsons H; Department of Microbiology, Laboratory Medicine, Northern General Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield S5 7AU, UK., Partridge D; Department of Microbiology, Laboratory Medicine, Northern General Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield S5 7AU, UK., Shaw D; Department of Respiratory Sciences, University of Leicester, Leicester, UK., Szakmany T; Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK., Todd S; Tropical and Infectious Disease Unit, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK., Thomas-Jones E; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK., Carrol ED; Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK., Shinkins B; Leeds Institute for Health Sciences, University of Leeds, Leeds, UK.; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2024 Aug 01; Vol. 79 (8), pp. 1831-1842.
DOI:	10.1093/jac/dkae167
Abstrakt:	Background: Many hospitals introduced procalcitonin (PCT) testing to help diagnose bacterial coinfection in individuals with COVID-19, and guide antibiotic decision-making during the COVID-19 pandemic in the UK. Objectives: Evaluating cost-effectiveness of using PCT to guide antibiotic decisions in individuals hospitalized with COVID-19, as part of a wider research programme. Methods: Retrospective individual-level data on patients hospitalized with COVID-19 were collected from 11 NHS acute hospital Trusts and Health Boards from England and Wales, which varied in their use of baseline PCT testing during the first COVID-19 pandemic wave. A matched analysis (part of a wider analysis reported elsewhere) created groups of patients whose PCT was/was not tested at baseline. A model was created with combined decision tree/Markov phases, parameterized with quality-of-life/unit cost estimates from the literature, and used to estimate costs and quality-adjusted life years (QALYs). Cost-effectiveness was judged at a £20 000/QALY threshold. Uncertainty was characterized using bootstrapping. Results: People who had baseline PCT testing had shorter general ward/ICU stays and spent less time on antibiotics, though with overlap between the groups' 95% CIs. Those with baseline PCT testing accrued more QALYs (8.76 versus 8.62) and lower costs (£9830 versus £10 700). The point estimate was baseline PCT testing being dominant over no baseline testing, though with uncertainty: the probability of cost-effectiveness was 0.579 with a 1 year horizon and 0.872 with a lifetime horizon. Conclusions: Using PCT to guide antibiotic therapy in individuals hospitalized with COVID-19 is more likely to be cost-effective than not, albeit with uncertainty. (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)
Databáze:	MEDLINE
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