Procalcitonin-guided antimicrobial stewardship for sepsis or lower respiratory tract infection in Thailand: a budget impact analysis
Anucha Apisarnthanarak, Piroon Mootsikapun, Pattarin Pirompanich, Pinyo Rattanaumpawan, Jiraporn Sri-on, Thavinee Trainarongsakul, Parichart Puangjakta, Osvaldo Ulises GarayAbstract
Objective:
To estimate the budget and healthcare impact of using procalcitonin (PCT)-guided antimicrobial stewardship for sepsis or lower respiratory tract infection (LRTI) in Thailand.
Design:
Cost and clinical outcomes were modeled, comparing intervention with PCT-guided antimicrobial stewardship plus routine practice versus standard of care. The primary outcome was the annual budget impact. Secondary outcomes were the duration of antibiotic treatment and numbers of antibiotic-resistant and Clostridioides difficile cases per year. Sensitivity analyses assessed parameter uncertainty. Scenario analyses explored the budget impact of variations in local clinical practice.
Setting:
Hospitalized patients with suspected sepsis or with LRTI in Thailand.
Intervention:
PCT-guided antimicrobial stewardship plus routine practice.
Results:
The model predicted that PCT-guided antimicrobial stewardship versus standard of care for sepsis and LRTI, respectively, would result in 270.6 (95% CI: −413.9, −160.2) and 917.1 (95% CI: −1,092.3, −421.5) thousand fewer antibiotic treatment days; 1.1 (95% CI: −2.3, −.5) and 23.2 (95% CI: –45.6, −7.9) thousand fewer antibiotic-resistant cases; and 4.5 (95% CI: −11.8, −1.0) and 13.2 (95% CI: −35.4, −2.1) thousand fewer Clostridioides difficile cases. Total cost savings were estimated at 921 THB (95% CI: −2,132, −7) and 3,320 THB (95% CI: −6,617, −592), per patient per year, for sepsis and LRTI, respectively. In sensitivity analyses, the probability of cost savings was 98% for sepsis and 100% for LRTI. Scenario analyses indicated that greater cost savings could be achieved in some scenarios.
Conclusions:
PCT-guided antimicrobial stewardship for sepsis and LRTI could deliver economic benefits compared with current standard of care in Thailand.