Budget impact analysis of using procalcitonin to optimize antimicrobial treatment for patients with suspected sepsis in the intensive care unit and hospitalized lower respiratory tract infections in Argentina

Abstract

Background Inappropriate antibiotic use represents a major global threat. Sepsis and bacterial lower respiratory tract infections (LRTIs) have been linked to antimicrobial resistance, carrying important consequences for patients and health systems. Procalcitonin-guided algorithms may represent helpful tools to reduce antibiotic overuse but the financial burden is unclear. The aim of this study was to estimate the healthcare and budget impact in Argentina of using procalcitonin-guided algorithms to guide antibiotic prescription. Methods A decision tree was used to model health and cost outcomes for the Argentinean health system, over a one-year duration. Patients with suspected sepsis in the intensive care unit and hospitalized patients with LRTI were included. Model parameters were obtained from a focused, non-systematic, local and international bibliographic search, and validated by a panel of local experts. Deterministic and probabilistic sensitivity analyses were performed to analyze the uncertainty of parameters. Results The model predicted that using procalcitonin-guided algorithms would result in 734.5 [95% confidence interval (CI): 1,105.2;438.8] thousand fewer antibiotic treatment days, 7.9 [95% CI: 18.5;8.5] thousand antibiotic-resistant cases avoided, and 5.1 [95% CI: 6.7;4.2] thousand fewer Clostridioides difficile cases. In total, this would save $422.4 US dollars (USD) [95% CI: $935;$267] per patient per year, meaning cost savings of $83.0 [95% CI: $183.6;$57.7] million USD for the entire health system and $0.4 [95% CI: $0.9;$0.3] million USD for a healthcare provider with 1,000 cases per year of sepsis and LRTI patients. The sensitivity analysis showed that the probability of cost-saving for the sepsis patient group was lower than for the LRTI patient group (85% vs. 100%). Conclusions Healthcare and financial benefits can be obtained by implementing procalcitonin-guided algorithms in Argentina. Although we found results to be robust on an aggregate level, some caution must be used when focusing only on sepsis patients in the intensive care unit.

Budget impact analysis of venetoclax for the management of acute myeloid leukemia from the perspective of the social security and the private sector in Argentina

“…Each third-party payer obtains its own acquisition cost. For this reason, the applied health economics studies conducted in the country could follow two approaches [ 36 , 37 ]: i) to use the retail price (PVP) or ii) to use the ex-factory price that is calculated as the PVP divided by 1.7545. The latest could be considered a more "realistic" approach, closer to the actual prices paid by different third-party payers.…”

The budget impact of procalcitonin-guided antibiotic stewardship compared to standard of care for patients with suspected sepsis admitted to the intensive care unit in Belgium

“…There is a difference in the cost investment per patient from the base-case analysis to the study by Garay et al, of €1.90 versus $-101, respectively. One reason for this difference in budget impact is that this study did not assess the impact of PCT on Clostridium difficile (C. diff) [21]. Furthermore, the main reason that PCT does not generate cost savings in the base-case for Belgium, compared with the study from Argentina, is that the cost of antibiotic treatment is more than six times higher in Argentina compared to Belgium [21].…”

“…This budget impact analysis simulates the cost and clinical effectiveness of PCT-guided antibiotic stewardship versus standard of care (SoC) for all patients with suspected sepsis in the ICU. The analysis is based on previously published decision trees [21,22], adapted to the Belgian healthcare system (Fig 1 ), where PCT tests are not reimbursed, thus not consistently used. For the reporting of results of economic assessments, the study followed the Belgian guidelines for economic evaluations and budget impact analyses [23], the International Society for Pharmacoeconomics and Outcomes budget impact analysis principles of good practice [24], and the Consolidated Health Economic Evaluation Reporting Standards statement [25].…”

“…This study was based on previously published studies that performed health economic evaluations for PCT-guided antibiotic stewardship in various countries, [ 21 , 22 ] and was adapted to the Belgian healthcare system; thus, base-case and scenario analyses were conducted ( Fig 1 ). The base-case analysis investigated the effectiveness of PCT based on antibiotic consumption and AMR cases.…”

“…This is done through health economic evaluations to inform decision-makers, which will ultimately benefit the healthcare system [19]. Health economic evaluations and cost analyses in patients with lower respiratory tract infections, or suspected sepsis in the ICU have been done for PCT-guided antibiotic stewardship in various countries, such as Argentina, the Netherlands, and the United States (US) [20][21][22]. To our knowledge, there have not been any budgetary analyses carried out in Belgium comprising patients with suspected sepsis in the ICU; thus, the aim of this study is to determine the budget impact of PCT-guided antibiotic stewardship in patients with suspected sepsis in the Belgian healthcare system, specifically those admitted to the ICU.…”