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

Webb, Edward J. D., Howdon, Daniel, Bestwick, Rebecca, King, Natalie, Sandoe, Jonathan A. T., Euden, Joanne ORCID: https://orcid.org/0000-0002-2844-6878, Grozeva, Detelina ORCID: https://orcid.org/0000-0003-3239-8415, West, Robert, Howard, Philip, Powell, Neil, Albur, Mahableshwar, Bond, Stuart, Brookes-Howell, Lucy ORCID: https://orcid.org/0000-0002-8263-7130, Dark, Paul, Hellyer, Thomas, Llewelyn, Martin, McCullagh, Iain J, Ogden, Margaret, Pallmann, Philip ORCID: https://orcid.org/0000-0001-8274-9696, Parsons, Helena, Partridge, David, Shaw, Dominick, Szakmany, Tamas ORCID: https://orcid.org/0000-0003-3632-8844, Todd, Stacy, Thomas-Jones, Emma ORCID: https://orcid.org/0000-0001-7716-2786, Carrol, Enitan D. and Shinkins, Bethany 2024. The cost-effectiveness of procalcitonin for guiding antibiotic prescribing in individuals hospitalized with COVID-19: part of the PEACH study. Journal of Antimicrobial Chemotherapy 79 (8) , pp. 1831-1842. 10.1093/jac/dkae167

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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
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:	08 Nov 2024 19:45
URI:	https://orca.cardiff.ac.uk/id/eprint/169797

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