title: Cost-effectiveness of procalcitonin-guided antibiotic use in community acquired pneumonia.
abstract: BACKGROUND
  Although prior randomized trials have demonstrated that procalcitonin-guided antibiotic therapy effectively reduces antibiotic use in patients with community-acquired pneumonia (CAP), uncertainties remain regarding use of procalcitonin protocols in practice.
  
  
  OBJECTIVE
  To estimate the cost-effectiveness of procalcitonin protocols in CAP.
  
  
  METHODS
  Decision analysis using published observational and clinical trial data, with variation of all parameter values in sensitivity analyses.
  
  
  METHODS
  Hypothetical patient cohorts who were hospitalized for CAP.
  
  
  METHODS
  Procalcitonin protocols vs. usual care.
  
  
  METHODS
  Costs and cost per quality adjusted life year gained.
  
  
  RESULTS
  When no differences in clinical outcomes were assumed, consistent with clinical trials and observational data, procalcitonin protocols cost $10-$54 more per patient than usual care in CAP patients. Under these assumptions, results were most sensitive to variations in: antibiotic cost, the likelihood that antibiotic therapy was initiated less frequently or over shorter durations, and the likelihood that physicians were nonadherent to procalcitonin protocols. Probabilistic sensitivity analyses, incorporating procalcitonin protocol-related changes in quality of life, found that protocol use was unlikely to be economically reasonable if physician protocol nonadherence was high, as observational study data suggest. However, procalcitonin protocols were favored if they decreased hospital length of stay.
  
  
  CONCLUSIONS
  Procalcitonin protocol use in hospitalized CAP patients, although promising, lacks physician nonadherence and resource use data in routine care settings, which are needed to evaluate its potential role in patient care.
authors: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. smithkj2@upmc.edu
authors: Kenneth J
authors: KJ
authors: Smith
authors: Angela
authors: A
authors: Wateska
authors: M Patricia
authors: MP
authors: Nowalk
authors: Mahlon
authors: M
authors: Raymund
authors: Bruce Y
authors: BY
authors: Lee
authors: Richard K
authors: RK
authors: Zimmerman
authors: Michael J
authors: MJ
authors: Fine
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002985:Clinical Protocols; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs / Q000706:statistics & numerical data; D016903:Drug Monitoring / Q000191:economics* / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics; D011498:Protein Precursors / Q000097:blood*; D019057:Quality-Adjusted Life Years; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide