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Cost-effectiveness of procalcitonin-guided antibiotic duration for hospitalized patients with sepsis
Stevenson, Matt Forsyth, Jessica E. Hossain, Anower Lall, Ranjit Dark, Paul ADAPT-Sepsis collaborators
Stevenson, Matt
Forsyth, Jessica E.
Hossain, Anower
Lall, Ranjit
Dark, Paul
ADAPT-Sepsis collaborators
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Epub Date
Issue Date
2025-11-28
Submitted date
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Abstract
Background: Procalcitonin (PCT)-guided antibiotic duration for critically ill adults with sepsis may be clinically effective and safe. However, cost-effectiveness analyses using clinical trial data for this precision medicine approach in critical care are lacking. This economic evaluation investigates the cost-effectiveness of a daily PCT-guided protocol to guide the duration of antibiotic treatment in adult patients with sepsis. Methods: Two analyses were conducted, the first estimating the cost per quality-adjusted life year (QALY) of the ADAPT-Sepsis study, which recruited 2760 patients randomized to a daily PCT-guided protocol, a daily C-reactive protein-guided protocol and standard care. The second analysis used meta-analyzed results from ADAPT-Sepsis and other PCT-guided treatment studies and employed a lifetime horizon. Key outcomes were the incremental costs and QALYs gained from using the daily PCT-guided protocol approach compared with standard care. Other outcome measures included changes in days of antibiotics, days of hospital stay, days of intensive care unit stay, the percentage of deaths and the number of PCT tests performed. Results: Cost-effectiveness results were driven by the assumed impact of PCT testing on mortality although the confidence/credible intervals for ADAPT-Sepsis and the meta-analyzed data both included no effect. Within ADAPT-Sepsis, the use of PCT tests cost €427 more per patient and was associated with a small QALY loss (0.001), which suggests the daily PCT-guided protocol is dominated. Using meta-analyzed data, the daily PCT-guided protocol was assumed to cost €330 more per patient but was associated with 0.139 more QALYs, resulting in a cost per QALY gained of €2384. If only antibiotic use and PCT tests were assumed to differ then PCT testing is estimated to cost no more than €110 per patient with QALYs equal in both arms regardless of whether ADAPT-Sepsis or meta-analyzed data were used. Conclusions: This economic analysis has shown that a PCT-guided protocol to guide the duration of antibiotic treatment could be cost-effective. Where only differences in antibiotic use and PCT testing are assumed, the increased costs per patient are modest which may be seen as worthwhile to safely improve antibiotic stewardship for critically ill adult patients with sepsis.
Citation
Stevenson, M., Forsyth, J.E., Hossain, A. et al. Cost-effectiveness of procalcitonin-guided antibiotic duration for hospitalized patients with sepsis. Critical Care 29, 508 (2025). https://doi.org/10.1186/s13054-025-05732-w
Publisher
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Research Unit
PubMed ID
41316366 (pubmed)
PubMed Central ID
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Type
Journal article
Language
en
Description
© 2025 The Authors. Published by Springer Nature. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1186/s13054-025-05732-w
Series/Report no.
ISSN
1364-8535
EISSN
1466-609X
ISBN
ISMN
Gov't Doc #
Sponsors
This study was supported by the NIHR following a commissioned call from the HTA programme (15/99/02).