Cost impact of procalcitonin-guided decision making on duration of antibiotic therapy for suspected early-onset sepsis in neonates

Abstract

Backgrounds The large, international, randomized controlled NeoPInS trial showed that procalcitonin (PCT)-guided decision making was superior to standard care in reducing the duration of antibiotic therapy and hospitalization in neonates suspected of early-onset sepsis (EOS), without increased adverse events. This study aimed to perform a cost-minimization study of the NeoPInS trial, comparing health care costs of standard care and PCT-guided decision making based on the NeoPInS algorithm, and to analyze subgroups based on country, risk category and gestational age. Methods Data from the NeoPInS trial in neonates born after 34 weeks of gestational age with suspected EOS in the first 72 h of life requiring antibiotic therapy were used. We performed a cost-minimization study of health care costs, comparing standard care to PCT-guided decision making. Results In total, 1489 neonates were included in the study, of which 754 were treated according to PCT-guided decision making and 735 received standard care. Mean health care costs of PCT-guided decision making were not significantly different from costs of standard care (€3649 vs. €3616). Considering subgroups, we found a significant reduction in health care costs of PCT-guided decision making for risk category ‘infection unlikely’ and for gestational age ≥ 37 weeks in the Netherlands, Switzerland and the Czech Republic, and for gestational age < 37 weeks in the Czech Republic. Conclusions Health care costs of PCT-guided decision making of term and late-preterm neonates with suspected EOS are not significantly different from costs of standard care. Significant cost reduction was found for risk category ‘infection unlikely,’ and is affected by both the price of PCT-testing and (prolonged) hospitalization due to SAEs.

Diagnostic Accuracy of Infection Markers to Diagnose Infections in Neonates and Children Receiving Extracorporeal Membrane Oxygenation

“…In addition to the traditional infection markers White Cell Count (WCC) and C-reactive protein (CRP), a large randomized-controlled trial in adult general ICU patients demonstrated superiority of a Procalcitonin (PCT) guided approach (20). Similarly, PCT guided therapy in neonates with suspected early-onset sepsis allowed to reduce the duration of antimicrobial therapy (21,22). While observational studies in critically ill children suggest superiority of PCR over CRP, adequately powered RCTs are lacking (23).…”

Reducing Antibiotic Exposure at the Beginning of Life

“…A systematic review and meta-analysis reporting the sensitivity of the Kaiser Permanente EOS calculator including more than 180 000 neonates demonstrated that, compared with the National Institute for Health and Care Excellence guidelines, the probability of the calculator missing a case of EOS was approximately 20% to 30% . Another promising initiative to support antimicrobial stewardship is the use of biomarker-guided antibiotic discontinuation algorithms, which should include embedded cost-effectiveness analyses . Implementation studies are warranted to explore clinicians’ beliefs and practices in relation to guideline compliance.…”