Health Economic Evaluation of Antimicrobial Stewardship, Procalcitonin Testing, and Rapid Blood Culture Identification in Sepsis Care: A 90-Day Model-Based, Cost-Utility Analysis

Simple item page
dc.contributor.authorSligl, Wendy I.
dc.contributor.authorYan, Charles
dc.contributor.authorRound, Jeff
dc.contributor.authorWang, Xiaoming
dc.contributor.authorChen, Justin Z.
dc.contributor.authorBoehm, Cheyanne
dc.contributor.authorFong, Karen
dc.contributor.authorCrick, Katelynn
dc.contributor.authorClua, Míriam G.
dc.contributor.authorCodan, Cassidy
dc.contributor.authorDingle, Tanis C.
dc.contributor.authorProsser, Connie
dc.contributor.authorChen, Guanmin
dc.contributor.authorTse-Chang, Alena
dc.contributor.authorGarros, Daniel
dc.contributor.authorZygun, David
dc.contributor.authorOpgenorth, Dawn
dc.contributor.authorConly, John M.
dc.contributor.authorDoig, Christopher J.
dc.contributor.authorLau, Vincent I.
dc.contributor.authorBagshaw, Sean M.
dc.date.accessioned2024-11-24T01:02:29Z
dc.date.available2024-11-24T01:02:29Z
dc.date.issued2024-11-19
dc.date.updated2024-11-24T01:02:29Z
dc.description.abstractAbstract Objective We evaluated the cost-effectiveness of a bundled intervention including an antimicrobial stewardship program (ASP), procalcitonin (PCT) testing, and rapid blood culture identification (BCID), compared with pre-implementation standard care in critically ill adult patients with sepsis. Methods We conducted a decision tree model-based cost-effectiveness analysis alongside a previously published pre- and post-implementation quality improvement study. We adopted a public Canadian healthcare payer’s perspective. Two intensive care units in Alberta with 727 adult critically ill patients were included. Our bundled intervention was compared with pre-implementation standard care. We collected healthcare resource use and estimated unit costs in 2022 Canadian dollars (CAD) over a time horizon from study entry to hospital discharge or death. We calculated the incremental net monetary benefit (iNMB) of the intervention group compared with the pre-intervention group. The primary outcome was cost per sepsis case. Secondary outcomes included readmission rates, Clostridioides difficile infections, mortality, and lengths of stay. Uncertainty was investigated using cost-effectiveness acceptability curves, cost-effectiveness plane scatterplots, and sensitivity analyses. Results Mean (standard deviation [SD]) cost per index hospital admission was CAD $83,251 ($107,926) for patients in the intervention group and CAD $87,044 ($104,406) for the pre-intervention group, though the difference ($3,793 [$7,897]) was not statistically significant. Costs were higher in the pre-intervention group for antibiotics, readmissions, and C. difficile infections. The intervention group had a lower mean expected cost; $110,580 ($108,917) compared with pre-intervention ($125,745 [$113,210]), with a difference of $15,165 ($8278). There were no statistically significant differences in quality adjusted life years (QALYs) between groups. The iNMB of the intervention group compared with pre-intervention was greater than $15,000 for willingness-to-pay (WTP) per QALY values of between $0 and $100,000. In our sensitivity analysis, the intervention was most likely to be cost-effective in roughly 56% of simulations at all WTP thresholds. Conclusions Our bundled intervention of ASP, PCT, and BCID among adult critically ill patients with sepsis was potentially cost-effective, but with substantial decision uncertainty.
dc.identifier.urihttps://doi.org/10.1007/s41669-024-00538-y
dc.identifier.urihttps://hdl.handle.net/1880/120100
dc.language.rfc3066en
dc.rights.holderThe Author(s)
dc.titleHealth Economic Evaluation of Antimicrobial Stewardship, Procalcitonin Testing, and Rapid Blood Culture Identification in Sepsis Care: A 90-Day Model-Based, Cost-Utility Analysis
dc.typeJournal Article
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
41669_2024_Article_538.pdf
Size:
818.34 KB
Format:
Adobe Portable Document Format
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Open Access Publications