title: Effect of Procalcitonin Testing on Health-care Utilization and Costs in Critically Ill Patients in the United States.
abstract: BACKGROUND
  There is a growing use of procalcitonin (PCT) to facilitate the diagnosis and management of severe sepsis. We investigated the impact of one to two PCT determinations on ICU day 1 on health-care utilization and cost in a large research database.
  
  
  METHODS
  A retrospective, propensity score-matched multivariable analysis was performed on the Premier Healthcare Database for patients admitted to the ICU with one to two PCT evaluations on day 1 of ICU admission vs patients who did not have PCT testing.
  
  
  RESULTS
  A total of 33,569 PCT-managed patients were compared with 98,543 propensity score-matched non-PCT patients. In multivariable regression analysis, PCT utilization was associated with significantly decreased total length of stay (11.6 days [95% CI, 11.4 to 11.7] vs 12.7 days [95% CI, 12.6 to 12.8]; 95% CI for difference, 1 to 1.3; P < .001) and ICU length of stay (5.1 days [95% CI, 5.1 to 5.2] vs 5.3 days [95% CI, 5.3 to 5.4]; 95% CI for difference, 0.1 to 0.3; P < .03), and lower hospital costs ($30,454 [95% CI, 29,968 to 31,033] vs $33,213 [95% CI, 32,964 to 33,556); 95% CI for difference, 2,159 to 3,321; P < .001). There was significantly less total antibiotic exposure (16.2 days [95% CI, 16.1 to 16.5] vs 16.9 days [95% CI, 16.8 to 17.1]; 95% CI for difference, -0.9 to 0.4; P = .006) in PCT-managed patients. Patients in the PCT group were more likely to be discharged to home (44.1% [95% CI, 43.7 to 44.6] vs 41.3% [95% CI, 41 to 41.6]; 95% CI for difference, 2.3 to 3.3; P = .006). Mortality was not different in an analysis including the 96% of patients who had an independent measure of mortality risk available (19.1% [95% CI, 18.7 to 19.4] vs 19.1% [95% CI, 18.9 to 19.3]; 95% CI for difference, -0.5 to 0.4; P = .93).
  
  
  CONCLUSIONS
  Use of PCT testing on the first day of ICU admission was associated with significantly lower hospital and ICU lengths of stay, as well as decreased total, ICU, and pharmacy cost of care. Further elucidation of clinical outcomes requires additional data.
authors: Division of Pulmonary and Critical Care Medicine, Rush Medical College and Rush University Medical Center, Chicago, IL. Electronic address: rbalk@rush.edu.
authors: Robert A
authors: RA
authors: Balk
authors: Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD.
authors: Sameer S
authors: SS
authors: Kadri
authors: Premier Research Services, Inc, Charlotte, NC.
authors: Zhun
authors: Z
authors: Cao
authors: Premier Research Services, Inc, Charlotte, NC.
authors: Scott B
authors: SB
authors: Robinson
authors: Premier Research Services, Inc, Charlotte, NC.
authors: Craig
authors: C
authors: Lipkin
authors: Medical Affairs-Americas/East Asia and Global Health Economics and Outcomes, bioMérieux USA, Durham, NC; Medicine and International Relations, University of California San Diego, San Diego, CA; Health Policy and Management, University of North Carolina, Raleigh, NC.
authors: Samuel A
authors: SA
authors: Bozzette
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000494:pharmacology; D002116:Calcitonin / Q000494:pharmacology*; D019963:Clinical Chemistry Tests / Q000379:methods / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy; D003710:Demography; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D002116:Calcitonin
keywords: antibiotic use; cost of care; intensive care unit; procalcitonin; sepsis