The cost-effectiveness of procalcitonin for guiding antibiotic prescribing in individuals hospitalized with COVID-19: part of the PEACH study
Authors: Webb Edward J D , Howdon Daniel , Bestwick Rebecca , King Natalie , Sandoe Jonathan A T , Euden Joanne , Grozeva Detelina , West Robert , Howard Philip , Powell Neil , Albur Mahableshwar , Bond Stuart , Brookes-Howell Lucy , Dark Paul , Hellyer Thomas , Llewelyn Martin , McCullagh Iain J , Ogden Margaret , Pallmann Philip , Parsons Helena , Partridge David , Shaw Dominick , Szakmany Tamas , Todd Stacy , Thomas-Jones Emma , Carrol Enitan D , Shinkins Bethany ,   PEACH Study Group, Sandoe Jonathan , Carrol Enitan , Thomas-Jones Emma , Brookes-Howell Lucy , Henley Josie , Maboshe Wakunyambo , Pallmann Philip , Grozeva Detelina , Bargiel Marcin , Evans Judith , Webb Edward , Bestwick Rebecca , Howdon Daniel , West Robert , Richman Colin , Gerver Sarah , Hope Russell , Hopkins Susan , Heginbothom Margaret , Howard Philip , Sandoe Jonathan , Berry Claire , Davis Georgina , Wilkinson Vikki , Todd Stacy , Taylor-Barr Eleanor , Brodsky Mary , Brown Jo , Burns Jenni , Glynn Sharon , Gureviciute Alvyda , Howard Megan , Kirkpatrick Jennifer , Murphy Hannah , Richardson Emma , Scanlon Deborah , Small Claire , Sweeney Graham , Williams Lisa , Szakmany Tamas , Baker Evelyn , Cheema Yusuf , Dunhill Jill , Killick Charlotte , King Charlie , Kooner Simran , Lewis Swyn , Nash Maxine , Richardson Owen , Tuffney Jemma , Westacott Clare , Williams Sarah , Partridge David , Parsons Helena , Cawthron Kay , Tai Yuen Kiu , Newman Thomas , Plowright Megan , Shulver Helen , Sivakova Anna , Powell Neil , Ayliffe Freddie , Darke Emma , Fletcher Eve , Hammonds Fiona , Marquez Gladys , Welch Leanne , Bond Stuart , Lee-Milner Jade , Spencer Joseph , Albur Mahableshwar , Brandao Rodrigo , Hrycaiczuk Joshua , Stanley Jack , Llewelyn Martin , Cross Elizabeth , Hansen Daniel , Redmore Ethan , Whyte Abigail , Hellyer Tom , McCullagh Iain , Brown Benjamin , Calabrese Michele , Cole Cameron , DeSousa Jessica , Dunn Leigh , Grieveson Stephanie , Gulati Arti , Issac Elizabeth , Mackay Ruaridh , Simoes Fatima , Dark Paul , Apatri Elena , Charles Bethan , Christensen Helen , Harvey Alice , Lomas Diane , Taylor Melanie , Thomas Vicky , Walker Danielle , Shaw Dominick , Howard Lucy , Joseph Amelia , Sultan Saheer , Knox-Macaulay Chikezie , Ogden Margaret , Prestwich Graham , Hamilton Ryan 
Published: June 2024

Abstract

Background
Many hospitals introduced procalcitonin (PCT) testing to help diagnose bacterial coinfection in individuals with COVID-19, and guide antibiotic decision-making during the COVID-19 pandemic in the UK.

Objectives
Evaluating cost-effectiveness of using PCT to guide antibiotic decisions in individuals hospitalized with COVID-19, as part of a wider research programme.

Methods
Retrospective individual-level data on patients hospitalized with COVID-19 were collected from 11 NHS acute hospital Trusts and Health Boards from England and Wales, which varied in their use of baseline PCT testing during the first COVID-19 pandemic wave. A matched analysis (part of a wider analysis reported elsewhere) created groups of patients whose PCT was/was not tested at baseline. A model was created with combined decision tree/Markov phases, parameterized with quality-of-life/unit cost estimates from the literature, and used to estimate costs and quality-adjusted life years (QALYs). Cost-effectiveness was judged at a £20 000/QALY threshold. Uncertainty was characterized using bootstrapping.

Results
People who had baseline PCT testing had shorter general ward/ICU stays and spent less time on antibiotics, though with overlap between the groups’ 95% CIs. Those with baseline PCT testing accrued more QALYs (8.76 versus 8.62) and lower costs (£9830 versus £10 700). The point estimate was baseline PCT testing being dominant over no baseline testing, though with uncertainty: the probability of cost-effectiveness was 0.579 with a 1 year horizon and 0.872 with a lifetime horizon.

Conclusions
Using PCT to guide antibiotic therapy in individuals hospitalized with COVID-19 is more likely to be cost-effective than not, albeit with uncertainty.