title: A PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis.
abstract: OBJECTIVE
  Procalcitonin (PCT) is a specific marker for differentiating bacterial from non-infective causes of inflammation. It can be used to guide initiation and duration of antibiotic therapy in intensive care unit (ICU) patients with suspected sepsis, and might reduce the duration of hospital stay. Limiting antibiotic treatment duration is highly important because antibiotic over-use may cause patient harm, prolonged hospital stay, and resistance development. Several systematic reviews show that a PCT algorithm for antibiotic discontinuation is safe, but upfront investment required for PCT remains an important barrier against implementation. The current study investigates to what extent this PCT algorithm is a cost-effective use of scarce healthcare resources in ICU patients with sepsis compared to current practice.
  
  
  METHODS
  A decision tree was developed to estimate the health economic consequences of the PCT algorithm for antibiotic discontinuation from a Dutch hospital perspective. Input data were obtained from a systematic literature review. When necessary, additional information was gathered from open interviews with clinical chemists and intensivists. The primary effectiveness measure is defined as the number of antibiotic days, and cost-effectiveness is expressed as incremental costs per antibiotic day avoided.
  
  
  RESULTS
  The PCT algorithm for antibiotic discontinuation is expected to reduce hospital spending by circa € 3503 per patient, indicating savings of 9.2%. Savings are mainly due to reductions in length of hospital stay, number of blood cultures performed, and, importantly, days on antibiotic therapy. Probabilistic and one-way sensitivity analyses showed the model outcome to be robust against changes in model inputs.
  
  
  CONCLUSIONS
  Proven safe, a PCT algorithm for antibiotic discontinuation is a cost-effective means of reducing antibiotic exposure in adult ICU patients with sepsis, compared to current practice. Additional resources required for PCT are more than offset by downstream cost savings. This finding is highly important given the aim of preventing widespread antibiotic resistance.
authors.affiliation: a a University of Twente , Enschede , The Netherlands.
authors.forename: Michelle M A
authors.initials: MM
authors.lastname: Kip
authors.affiliation: b b University of Twente, Enschede, The Netherlands; and Jeroen Bosch Hospital , Den Bosch , The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: Kusters
authors.affiliation: c c University of Twente, Enschede, The Netherlands; and PANAXEA B.V. , Enschede , The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: IJzerman
authors.affiliation: d d PANAXEA B.V., Enschede, The Netherlands; and Fred Hutchinson Cancer Research Center , Seattle , USA.
authors.forename: Lotte M G
authors.initials: LM
authors.lastname: Steuten
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D015415:Biomarkers; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003956:Dialysis / Q000191:economics; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D009426:Netherlands; D011498:Protein Precursors / Q000097:blood*; D012121:Respiration, Artificial / Q000191:economics; D018805:Sepsis / Q000097:blood* / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: Antibiotics; Cost-effectiveness; Intensive care; Procalcitonin; Sepsis