The cost-effectiveness of procalcitonin for guiding antibiotic prescribing in individuals hospitalized with COVID-19: part of the PEACH study

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Webb, EJD ORCID: 0000-0001-7918-839X, Howdon, D, Bestwick, R, King, N, Sandoe, JAT ORCID: 0000-0003-0193-8677, Euden, J ORCID: 0000-0002-2844-6878, Grozeva, D ORCID: 0000-0003-3239-8415, West, R, Howard, P ORCID: 0000-0002-5096-0240, Powell, N ORCID: 0000-0002-6113-9810 et al (show 28 more authors) , Albur, M, Bond, S ORCID: 0000-0001-9640-2474, Brookes-Howell, L, Dark, P ORCID: 0000-0003-3309-0164, Hellyer, T, Llewelyn, M, McCullagh, IJ, Ogden, M, Pallmann, P, Parsons, H, Partridge, D ORCID: 0000-0002-0417-2016, Shaw, D, Szakmany, T, Todd, S, Thomas-Jones, E, Carrol, ED ORCID: 0000-0001-8357-7726, Shinkins, B, Henley, J, Maboshe, W, Bargiel, M, Evans, J, Howdon, D, Richman, C, Gerver, S, Hope, R, Hopkins, S, Heginbothom, M and Howard, P (2024) The cost-effectiveness of procalcitonin for guiding antibiotic prescribing in individuals hospitalized with COVID-19: part of the PEACH study Journal of Antimicrobial Chemotherapy, 79 (8). pp. 1831-1842. ISSN 0305-7453, 1460-2091

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Abstract

Background: Many hospitals introduced procalcitonin (PCT) testing to help diagnose bacterial coinfection in individuals with COVID-19, and guide antibiotic decision-making during the COVID-19 pandemic in the UK. Objectives: Evaluating cost-effectiveness of using PCT to guide antibiotic decisions in individuals hospitalized with COVID-19, as part of a wider research programme. Methods: Retrospective individual-level data on patients hospitalized with COVID-19 were collected from 11 NHS acute hospital Trusts and Health Boards from England and Wales, which varied in their use of baseline PCT testing during the first COVID-19 pandemic wave. A matched analysis (part of a wider analysis reported elsewhere) created groups of patients whose PCT was/was not tested at baseline. A model was created with combined decision tree/Markov phases, parameterized with quality-of-life/unit cost estimates from the literature, and used to estimate costs and quality-adjusted life years (QALYs). Cost-effectiveness was judged at a £20000/QALY threshold. Uncertainty was characterized using bootstrapping. Results: People who had baseline PCT testing had shorter general ward/ICU stays and spent less time on antibiotics, though with overlap between the groups’ 95% CIs. Those with baseline PCT testing accrued more QALYs (8.76 versus 8.62) and lower costs (£9830 versus £10 700). The point estimate was baseline PCT testing being dominant over no baseline testing, though with uncertainty: the probability of cost-effectiveness was 0.579 with a 1 year horizon and 0.872 with a lifetime horizon. Conclusions: Using PCT to guide antibiotic therapy in individuals hospitalized with COVID-19 is more likely to be cost-effective than not, albeit with uncertainty.

Item Type:	Article
Uncontrolled Keywords:	PEACH Study Group, Humans, Bacterial Infections, Anti-Bacterial Agents, Hospitalization, Retrospective Studies, Quality-Adjusted Life Years, Adult, Aged, Middle Aged, Cost-Benefit Analysis, Female, Male, United Kingdom, Procalcitonin, COVID-19, SARS-CoV-2, COVID-19 Drug Treatment
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Infection, Vet & Ecological Sciences
Depositing User:	Symplectic Admin
Date Deposited:	10 Jun 2024 09:30
Last Modified:	28 Feb 2026 20:49
DOI:	10.1093/jac/dkae167
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3182092
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