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

A J L M Geraerds,Eline G Visser,Urs Zimmerman,Frank A B A Schuerman ,Jantien W Wieringa ,Laura H Van Der Meer-Kappelle ,Matteo Fontana ,Arjen Mol ,Rita K Van Den Tooren-De Groot ,Albertine E Donker,Salhab El Helou,Juliette Van Gijsel,Wendy Van Herk,Sourabh Dutta,Rob Moonen,Maren Tomaske,Martin Stocker,Madan Roy,René F Kornelisse,Sintha D Sie,Luregn J Schlapbach,Annemarie M C Van Rossum,Esther De Vries,Angelique Hoffman-Haringsma,Jan Janota,Suzanne Polinder

doi:10.1186/s13054-021-03789-x

Abstract

BackgroundsThe 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.MethodsData 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.ResultsIn 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.ConclusionsHealth 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.

Highlights

Early-onset sepsis (EOS) is one of the main causes for hospitalization in the first week of life
Antibiotic treatment is associated with undesirable consequences, such as hospital admission, neonatal and parental discomfort, alterations in the neonatal microbiome and the use of health care resources, which puts a high demand on health care costs [2, 3]
Study design This study explored the total direct medical costs of PCTguided decision making in neonates with suspected EOS from a hospital-based perspective

Summary

Introduction

Early-onset sepsis (EOS) is one of the main causes for hospitalization in the first week of life. Approximately 4–7% of term and late-preterm neonates in highincome countries are treated with intravenous antibiotics because of suspected EOS, whereas the prevalence of EOS is only 0.1% [1]. This implicates unnecessary antibiotic treatment in the majority of the treated neonates. A previous patent on the PCT-test has expired, which has led to more market competition, and a lower price for the PCT-test kit. This has resulted in lower costs of PCT-testing and might result in PCT-guided decision making being more cost-effective

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