Webb, Edward J. D., Howdon, Daniel, Bestwick, Rebecca, King, Natalie, Sandoe, Jonathan A. T., Euden, Joanne ![]() ![]() ![]() ![]() ![]() ![]() ![]() |
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Abstract
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.
Item Type: | Article |
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Date Type: | Publication |
Status: | Published |
Schools: | Medicine Centre for Trials Research (CNTRR) |
Publisher: | Oxford University Press |
ISSN: | 0305-7453 |
Date of First Compliant Deposit: | 13 June 2024 |
Date of Acceptance: | 2 May 2024 |
Last Modified: | 07 Aug 2024 22:20 |
URI: | https://orca.cardiff.ac.uk/id/eprint/169797 |
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