1860. Implementation of a Procalcitonin-Guided Antimicrobial Use in Intensive Care Unit Patients with Sepsis: A Cost-Effectiveness Analysis Utilizing Real-World Experiences
Session: Poster Abstract Session: Antibiotic Stewardship: Diagnostics
Saturday, October 29, 2016
Room: Poster Hall
Background: Economic modeling studies have predicted that procalcitonin (PCT) testing may be cost-effective in patients with suspected sepsis; however, results are based on a number of assumptions and variables including appropriate algorithm compliance. The objective of this study was to assess whether PCT use was cost-effective following implementation at a community hospital.

Methods: A piggyback cost-effectiveness analysis was performed following an analysis of patients with a PCT order diagnosed with sepsis and admitted to the intensive care unit (ICU) between February – July, 2015. These patients were compared to a pre-intervention group admitted to the ICU between February – July, 2014 who would have met criteria for a PCT order. We evaluated algorithm adherence, antimicrobial duration and adverse events, ICU length of stay, 30-day readmission rates, and mortality between groups using a quasi-experimental pre-post design. Results were then used to populate a decision analytic model comparing PCT use with standard care. The robustness of our model was tested against all relevant scenarios via univariate and probabilistic sensitivity analyses.

Results: A total of 124 patients were reviewed, 51 patients in the pre-intervention group and 73 patients in the post-intervention group. Patients in the post-intervention group met all targets required by previous analyses to demonstrate cost-effectiveness. These included algorithm adherence and reduced antimicrobial use. As predicted, PCT use dominated standard care in our patient population. There was a decrease in treatment costs of $162 per patient and a gain of 0.0001 quality-adjusted life years. We predicted an annual savings of $89,100 and a reduction in Clostridium difficileinfection (22%) and antimicrobially-induced nephrotoxicity (22%) following implementation. The model was sensitive to a number of variables including the probability of a low PCT level (5%), the number of PCT tests per patient (5.7), and algorithm adherence (17%).

Conclusion: Implementation of a PCT-guided treatment algorithm confirmed modeling estimates and improved patients' quality of life while decreasing costs in ICU patients with suspected bacterial infection and sepsis.

Curtis Collins, PharmD, MS1, Kara Brockhaus, PharmD1, Taeyong Sim, MD1, Anupam Suneja, MD1 and Anurag Malani, MD, FIDSA2, (1)St. Joseph Mercy Health System, Ann Arbor, MI, (2)St. Joseph Mercy Health System, Ypsilanti, MI

Disclosures:

C. Collins, None

K. Brockhaus, None

T. Sim, None

A. Suneja, None

A. Malani, None

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