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

• Published in: Journal of antimicrobial chemotherapy Vol. 79; no. 8; pp. 1831 - 1842
• Main Authors: Webb, Edward J D, Howdon, Daniel, Bestwick, Rebecca, King, Natalie, Sandoe, Jonathan A T, Euden, Joanne, Grozeva, Detelina, West, Robert, Howard, Philip, Powell, Neil, Albur, Mahableshwar, Bond, Stuart, Brookes-Howell, Lucy, Dark, Paul, Hellyer, Thomas, Llewelyn, Martin, McCullagh, Iain J, Ogden, Margaret, Pallmann, Philip, Parsons, Helena, Partridge, David, Shaw, Dominick, Szakmany, Tamas, Todd, Stacy, Thomas-Jones, Emma, Carrol, Enitan D, Shinkins, Bethany
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.08.2024
• Subjects: Adult; Aged; Anti-Bacterial Agents - economics; Anti-Bacterial Agents - therapeutic use; Bacterial Infections - drug therapy; Bacterial Infections - economics; Cost-Benefit Analysis; COVID-19; COVID-19 Drug Treatment; Female; Hospitalization - economics; Humans; Male; Middle Aged; Original Research; Procalcitonin - blood; Quality-Adjusted Life Years; Retrospective Studies; SARS-CoV-2; United Kingdom; United Kingdom
• ISSN: 0305-7453; 1460-2091; 1460-2091
• DOI: 10.1093/jac/dkae167

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. Evaluating cost-effectiveness of using PCT to guide antibiotic decisions in individuals hospitalized with COVID-19, as part of a wider research programme. 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. 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. Using PCT to guide antibiotic therapy in individuals hospitalized with COVID-19 is more likely to be cost-effective than not, albeit with uncertainty.