Is Procalcitonin Biomarker-Guided Antibiotic Therapy a Cost-Effective Approach to Reduce Antibiotic Resistant and Clostridium difficile Infections in Hospitalized Patients?

Autor: Hubertus J. M. Vrijhoef, Isabelle Lepage-Nefkens, Janne C. Mewes, Lotte Maria Gertruda Steuten
Přispěvatelé: RS: CAPHRI - R2 - Creating Value-Based Health Care, MUMC+: KIO Kemta (9), Health Services Research, Family Medicine and Chronic Care
Rok vydání: 2018
Předmět:
medicine.medical_specialty
economic evaluation
INTENSIVE-CARE-UNIT
Population
RESPIRATORY-TRACT INFECTIONS
antibiotic stewardship
Biochemistry
Procalcitonin
law.invention
chronic obstructive pulmonary disease
Sepsis
03 medical and health sciences
0302 clinical medicine
Antibiotic resistance
Randomized controlled trial
law
SERUM PROCALCITONIN
Germany
ECONOMIC BURDEN
Genetics
Medicine
Humans
030212 general & internal medicine
ALGORITHM
education
Molecular Biology
METAANALYSIS
Netherlands
COPD
education.field_of_study
Respiratory tract infections
SEPSIS
business.industry
ADULTS
RANDOMIZED CONTROLLED-TRIAL
medicine.disease
Intensive care unit
United Kingdom
Anti-Bacterial Agents
030228 respiratory system
Emergency medicine
Clostridium Infections
Molecular Medicine
HEALTH
business
Biomarkers
Biotechnology
Zdroj: OMICS-a journal of Integrative Biology, 22(9), 616-625. Mary Ann Liebert Inc.
ISSN: 1557-8100
1536-2310
Popis: Antibiotics (AB) can reduce morbidity and mortality in the treatment of patients with sepsis and chronic obstructive pulmonary disease (COPD) exacerbations. Yet, AB overuse or misuse increases antibiotic resistance (ABR) and Clostridium difficile infections (CDI). This study projected the expected impact of a procalcitonin (PCT) biomarker testing strategy on incremental ABR cases and CDI, and costs of care in a population of patients hospitalized with suspected sepsis or a COPD exacerbation, in three European countries: the United Kingdom, Germany, and the Netherlands. Based on a systematic literature search and a decision model, we analyzed the number of ABR and CDI cases avoided and the incremental healthcare costs per patient from a societal perspective over the time horizon of a hospital stay. In the sepsis population, the PCT-guided antibiotic prescription strategy was projected to reduce the number of ABR cases with circa 6%, the number of CDI cases with 21%, and societal costs with circa Euro1300 per patient. In the COPD population, the number of ABR and CDI cases is reduced with circa 50%, and societal cost savings ranged Euro1701, Euro2473, and Euro2435 per patient in Germany, the Netherlands, and the United Kingdom, respectively. Model outcomes were most sensitive to the impact of the PCT-guided strategy on the number of intensive care unit days and general hospital ward days. Taken together, a PCT biomarker-guided antibiotic management strategy is likely to reduce the number of ABR and CDI cases and generate cost savings in a population of patients hospitalized with suspected sepsis or with a COPD exacerbation.
Databáze: OpenAIRE
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