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

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

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Backgrounds
The 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.

Methods
Data 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.

Results
In 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.

Conclusions
Health 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.
Original languageEnglish
Article number367
JournalCritical Care
Volume25
DOIs
Publication statusPublished - 2021

Keywords

  • Neonates
  • procalcitonin-guided decision making
  • sepsis
  • COSTS

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