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Understanding the true value of procalcitonin (PCT) testing

Home Economic Impact

Understanding the true value of procalcitonin (PCT) testing

Understanding the true value of procalcitonin testing

Healthcare leaders ask two questions when considering a change in their testing protocols, “How will the new approach improve the quality of care? And how much will it cost?”

We understand that implementing a new test is a major undertaking. You and others in your organization may need assurance that the switch to PCT is manageable and cost-effective. Fortunately, transitioning to PCT testing need not be a leap of faith.

With B·R·A·H·M·S PCT™ (procalcitonin), the answers are clear; PCT testing leads to better clinical outcomes and lower costs. Equipped with this information, leaders can make informed decisions about including PCT in their organization's testing regimes.

Numerous studies show that PCT can provide clinical benefits while delivering significant savings. Here are a few interesting studies:

Discover what the economic impact of PCT can mean for your hospital with a custom economic model.
Discover what the economic impact of PCT can mean for your hospital with a custom economic model.

Integrating B·R·A·H·M·S PCT into clinical decision-making can reduce initial antibiotic prescription rates and antibiotic treatment duration, which in turn lowers the likelihood of antibiotic related adverse events and length of hospitalization. PCT-aided therapy also leads to improved outcomes and reduced costs.4-8

U.S. Cost Effectiveness Literature: Significant overall hospital savings with PCT aided care

Cost-effectiveness literature from Europe9 the Asia-Pacific region,10-12 Latin America13, and the U.S.14,15 indicates that adding PCT testing to antibiotic stewardship protocols leads to cost savings for health care systems.


Data from U.S. healthcare systems provide an estimate of the economic impact of PCT use. The healthcare impacts were quantified and integrated into a model based analysis using a previously published health economic decision-tree model to compare the costs and effects of procalcitonin-aided care. The analysis considered the societal and hospital perspective with a time horizon covering the length of hospital stay. The main outcomes for comparison were total costs per patient—including treatment costs and productivity losses—the number of patients with antibiotic resistant or Clostridioides difficile (C. diff) infections, and costs per antibiotic day avoided.14

Results from the U.S meta-analysis results demonstrated that PCT-aided antibiotic stewardship versus standard care can lead to significant overall hospital savings: $11,311 per sepsis patient and $2,867 per LRTI patient.14

Cost and clinical efficacy impact includes:14

Antibiotic resistance

  • Decreased C. diff rates
  • Decreased average length of stay
  • Decreased antibiotic treatment duration

Cost drivers and important clinical parameters 

Clinical quality and reimbursement impacts

Spurred by a call to action from the World Health Organization, many countries have set up national antibiotic stewardship programs. These programs encourage hospitals to improve patient safety and implement best practices for reducing rates of infection.

In conjunction with antibiotic stewardship programs, health authorities are also using surveys to track the quality of care delivered against predefined benchmarks. Moreover, some countries now include quality metrics in their hospital reimbursement criteria.

Among these quality metrics are infection rates of pathogens such as C. diff and methicillin-resistant Staphylococcus aureus (MRSA). Using B·R·A·H·M·S PCT, hospitals are better able to lower both their sepsis and readmission rates, and as a result maintain their reimbursement revenue. 

PCT proves its value in clinical trial

A recently published randomized controlled trial—Procalcitonin-Guided Antimicrobial Therapy in Sepsis (PROGRESS) —sought to determine whether PCT-aided antibiotic therapy reduced the incidence of longterm, infection-associated adverse events in cases of sepsis.17 The trial demonstrated that using PCT to aid antimicrobial treatment in sepsis patients was effective in reducing antibiotic-associated adverse events, such as antibiotic resistance infections. In addition, it was found that PCT testing lowered 28-day mortality and resulted in a median length of therapy 50% shorter than standard treatments.17

 

Analysis of U.S. hospital data shows the cost-effectiveness of PCT-aided decision-making

According to one study, PCT-aided antibiotic stewardship decreased the average cost per patient for sepsis and LRTI in a U.S. hospital setting.15

The study looked at patient data from the Five Rivers Medical Center in Pocahontas, Ark., and found that PCT-aided therapy led to the following cost reductions:15

Sepsis treatment costs and productivity losses:
-$25,611 (49% reduction)

LRTI treatment costs and productivity losses:
-$3,630 (23% reduction)

Antibiotic resistance
The main drivers of cost reduction included length of stay, the costs of the hospital stay, and, for patients with LRTI, the percentage of patients receiving antibiotics. 15

The estimated number of patients with antibiotic-resistant infections and C. diff infections was reduced considerably—for example, among LRTI patients there was a 73.7% reduction in C. diff infections.15 No C. diff infections were reported in patients diagnosed with sepsis. It was also estimated that the number of antibioticresistant patients with sepsis and LRTI declined 8% and 17.2%, respectively. 15

*No C. diff infection patients were reported for sepsis during study period.

PCT-aided antibiotic stewardship and the impact on C. diff infections (CDI)

Long term use of antibiotics and cumulative exposure are significant risk factors for18

  • CDI is estimated to cause almost half a million illnesses in the United States each year, and an estimated 29,300 deaths19
  • About 1 in 6 patients with CDI will get it again in the subsequent 2–8 weeks19
  • One in 11 people over 65 diagnosed with a healthcare-associated CDI die within a month.20

 

Strong evidence supports safe reduction of antibiotics when using PCT-aided antibiotic stewardship protocols21-25

The cost impact of CDI

  • Possible CMS 1% penalty on Medicare reimbursement to hospitals experiencing HAI rates (CLABSI, CAUTI, SSI, MRSA, CDI) in the top 25th percentile26
  • Average total costs for CDI management per case were $21,44827

Drive impact or risk the cost of inaction

Investing in change can be daunting, but when it comes to implementing PCT-aided therapy the case for change is obvious—better antibiotic prescribing, lower rates of antibiotic resistance, fewer C. diff infections, improved patient outcomes, and lower costs.14

Is your hospital ready to move forward with PCT?

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References
  1. Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011 Sep 22;9:107. 
  2. Meisner M. Procalcitonin-biochemistry and clinical diagnosis. Dresden (Germany): UNI-MEDVerlag; 2010. 
  3. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Genacay MM, Huber PR, Tamm M, et al., Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet Infect Dis. 2004 Feb 21;363(9409):600-7. 
  4. de Jong E, van Oers J, Beishuizen A, Vos P, Vermeijden W, Haas L, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: A randomised, controlled, open-label trial. Lancet Infect Dis. 2016 Jul 1;16(7):819-27. 
  5. Briel M, Schuetz P, Mueller B, Young J, Schild U, Nusbaumer C, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med. 2008 Oct 13;168(18):2000-7. 
  6. Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: A randomized trial. Am J Resp Crit Care Med. 2008 Mar 1;177(5):498-505. 
  7.  Esposito S, Tagliabue C, Picciolli I, Semino M, Sabatini C, Consolo S, et al. Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia. Respir Med. 2011 Dec;105(12):1939-45. 
  8. Kip MM, Kusters R, IJzerman MJ, Steuten LM. A PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis. J Med Econ. 2015;18(11):944-53. 
  9. Steuten L, Mewes J, Lepage-Nefkens I, Vrijhoef H. Is procalcitonin biomarker-guided antibiotic therapy a cost-effective approach to reduce antibiotic resistant and clostridium difficile infections in hospitalized patients? OMICS. 2018;22 (9),Sep: 616-625.  
  10. Ito A, Ishida T, Tokumasu H, Washio Y, Yamazaki A, Ito Y, et al. Impact of procalcitonin-guided therapy for hospitalized community-acquired pneumonia on reducing antibiotic consumption and costs in Japan. J Infect Chemother. 2017;23 (3),Mar: 142-147. 
  11. Loo LW, Liew YX, Lee W, Lee LW, Chlebicki P, Kwa AL. Discontinuation of antibiotic therapy within 24 hours of treatment initiation for patients with no clinical evidence of bacterial infection: A 5- year safety and outcome study from Singapore General Hospital Antimicrobial Stewardship Program. Int J Antimicrob Agents. 2019;53 (5),May: 606-611. 
  12. Stojanovic I, Schneider JE, Wei L, Hong Z, Keane C, Schuetz P. Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: A Chinese hospital system perspective. Clin Chem Lab Med. 2017;55 (4),Mar 1: 561-570. 
  13. Schneider JE, Stojanovic I, Vargas C, Schuetz P, Giglio A. Economic evaluation of procalcitoninguided antibiotic therapy in acute respiratory infections: A chile health system perspective. Value Health. 2016;19 (3),May: A306. 
  14. Mewes JC, Pulia MS, Mansour MK, Broyles MR, Nguyen HB, Steuten LM. The cost impact of PCTaided antibiotic stewardship versus usual care for hospitalised patients with suspected sepsis or Page 9 Website PCT Global Clinical Economic Impact EN lower respiratory tract infections in the US: A health economic model analysis. PloS one. 2019 Apr 23;14(4):e0214222. 
  15. Voermans AM, Mewes JC, Broyles MR, Steuten LM. Cost-effectiveness analysis of a procalcitoninguided decision algorithm for antibiotic stewardship using real-world us hospital data. OMICS. 2019 Oct 1;23(10):508-15. 
  16. Centers for Disease Control and Prevention. Hospital-acquired condition reduction program (HACRP) [Internet]. Atlanta (GA). Feb 11; cited 2020 Dec 14] Available here. 
  17. Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, Panagaki A, Melachroinopoulos N, Drakou E, Marousis K, et al. Procalcitonin to reduce long-term infection-associated adverse events in sepsis: a randomized trial. Am J Respir Crit Care Med. 2020 Aug 6
  18. Stevens V, Dumyati G, Fine LS, Fisher SG, van Wijngaarden E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis. 2011 Jul 1;53(1):42-8. doi: 10.1093/cid/cir301. PMID: 21653301
  19. Guh AY, Mu Y, Winston LG et al. N Engl J Med 2020;382:1320–30. DOI: 10.1056/NEJMoa1910215
  20. Lessa FC, Mu Yi, Bamberg WM et al. N Engl J Med 2015;372:825–34. DOI: 10.1056/NEJMoa1408913
  21. Walsh TL, DiSilvio BE, Hammer C, et al. Impact of Procalcitonin Guidance with an Educational Program on Management of Adults Hospitalized with Pneumonia. Am J Med. 2018;131(2):201.e1-201.e8. doi:10.1016/j.amjmed.2017.08.039
  22. Bremmer, D.N., DiSilvio, B.E., Hammer, C. et al. Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations. J GEN INTERN MED 33, 692–697 (2018). https://doi.org/10.1007/s11606-018-4312-2
  23. Kevin Lin, PharmD, Casey Dempsey, PharmD, Shivani Patel, PharmD, BCPS, John Butler, MD, Edward Septimus, MD, FIDSA, FSHEA, 1479. Evaluating the Impact of Procalcitonin on Antibiotic Utilization in Chronic Obstructive Pulmonary Disease Exacerbations, Open Forum Infectious Diseases, Volume 5, Issue suppl_1, November 2018, Pages S457–S458, https://doi.org/10.1093/ofid/ofy210.1308
  24. Johnson SA, Rupp AB, Rupp KL, Reddy S. Clinical outcomes and costs associated with procalcitonin utilization in hospitalized patients with pneumonia, heart failure, viral respiratory infection, or chronic obstructive pulmonary disease. Intern Emerg Med. 2021;16(3):677-686. doi:10.1007/s11739-020-02618-3
  25. Broyles MR. Impact of Procalcitonin-Guided Antibiotic Management on Antibiotic Exposure and Outcomes: Real-world Evidence. Open Forum Infect Dis. 2017;4(4):ofx213. Published 2017 Oct 3. doi:10.1093/ofid/ofx213
  26. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program
  27. Zhang, Shanshan et al. “Cost of hospital management of Clostridium difficile infection in United States-a meta-analysis and modelling study.” BMC infectious diseases vol. 16,1 447. 25 Aug. 2016, doi:10.1186/s12879-016-1786-6
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