title: Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective.
abstract: BACKGROUND
  Whether or not antibiotic stewardship protocols based on procalcitonin levels results in cost savings remains unclear. Herein, our objective was to assess the economic impact of adopting procalcitonin testing among patients with suspected acute respiratory tract infection (ARI) from the perspective of a typical US integrated delivery network (IDN) with a 1,000,000 member catchment area or enrollment.
  
  
  METHODS
  To conduct an economic evaluation of procalcitonin testing versus usual care we built a cost-impact model based on patient-level meta-analysis data of randomized trials. The meta-analytic data was adapted to the US setting by applying the meta-analytic results to US lengths of stay, costs, and practice patterns. We estimated the annual ARI visit rate for the one million member cohort, by setting (inpatient, ICU, outpatient) and ARI diagnosis.
  
  
  RESULTS
  In the inpatient setting, the costs of procalcitonin-guided compared to usual care for the one million member cohort was $2,083,545, compared to $2,780,322, resulting in net savings of nearly $700,000 to the IDN for 2014. In the ICU and outpatient settings, savings were $73,326 and $5,329,824, respectively, summing up to overall net savings of $6,099,927 for the cohort. RESULTS were robust for all ARI diagnoses. For the whole US insured population, procalcitonin-guided care would result in $1.6 billion in savings annually.
  
  
  CONCLUSIONS
  Our results show substantial savings associated with procalcitonin protocols of ARI across common US treatment settings mainly by direct reduction in unnecessary antibiotic utilization. These results are robust to changes in key parameters, and the savings can be achieved without any negative impact on treatment outcomes.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.forename: Robert
authors.initials: R
authors.lastname: Balk
authors.forename: Matthias
authors.initials: M
authors.lastname: Briel
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutz
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Kristina B
authors.initials: KB
authors.lastname: Kristoffersen
authors.forename: Long
authors.initials: L
authors.lastname: Wei
authors.forename: Olaf
authors.initials: O
authors.lastname: Burkhardt
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Stefan
authors.initials: S
authors.lastname: Schroeder
authors.forename: Vandack
authors.initials: V
authors.lastname: Nobre
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.forename: Neera
authors.initials: N
authors.lastname: Bhatnagar
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lacey
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ohsfeldt
authors.forename: Cara M
authors.initials: CM
authors.lastname: Scheibling
authors.forename: John E
authors.initials: JE
authors.lastname: Schneider
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001774:Blood Chemical Analysis / Q000191:economics*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D015201:Meta-Analysis as Topic; D011498:Protein Precursors / Q000097:blood*; D012141:Respiratory Tract Infections / Q000097:blood* / Q000188:drug therapy* / Q000191:economics; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide