IDEAS home Printed from https://ideas.repec.org/a/spr/pharmo/v9y2025i1d10.1007_s41669-024-00538-y.html
   My bibliography  Save this article

Health Economic Evaluation of Antimicrobial Stewardship, Procalcitonin Testing, and Rapid Blood Culture Identification in Sepsis Care: A 90-Day Model-Based, Cost-Utility Analysis

Author

Listed:
  • Wendy I. Sligl

    (University of Alberta and Alberta Health Services
    University of Alberta)

  • Charles Yan

    (Institute of Health Economics)

  • Jeff Round

    (Institute of Health Economics)

  • Xiaoming Wang

    (Alberta Health Services
    Alberta SPOR SUPPORT Unit)

  • Justin Z. Chen

    (University of Alberta)

  • Cheyanne Boehm

    (Alberta Health Services)

  • Karen Fong

    (Alberta Health Services)

  • Katelynn Crick

    (University of Alberta and Alberta Health Services)

  • Míriam Garrido Clua

    (University of Alberta and Alberta Health Services)

  • Cassidy Codan

    (University of Calgary and Alberta Health Services)

  • Tanis C. Dingle

    (University of Alberta
    Alberta Precision Laboratories)

  • Connie Prosser

    (University of Alberta)

  • Guanmin Chen

    (University of Calgary)

  • Alena Tse-Chang

    (University of Alberta)

  • Daniel Garros

    (University of Alberta)

  • David Zygun

    (University of Alberta and Alberta Health Services)

  • Dawn Opgenorth

    (University of Alberta and Alberta Health Services)

  • John M. Conly

    (University of Calgary and Alberta Health Services
    University of Calgary)

  • Christopher J. Doig

    (Alberta Health Services)

  • Vincent I. Lau

    (University of Alberta and Alberta Health Services)

  • Sean M. Bagshaw

    (University of Alberta and Alberta Health Services
    Alberta Health Services)

Abstract

Objective We evaluated the cost-effectiveness of a bundled intervention including an antimicrobial stewardship program (ASP), procalcitonin (PCT) testing, and rapid blood culture identification (BCID), compared with pre-implementation standard care in critically ill adult patients with sepsis. Methods We conducted a decision tree model-based cost-effectiveness analysis alongside a previously published pre- and post-implementation quality improvement study. We adopted a public Canadian healthcare payer’s perspective. Two intensive care units in Alberta with 727 adult critically ill patients were included. Our bundled intervention was compared with pre-implementation standard care. We collected healthcare resource use and estimated unit costs in 2022 Canadian dollars (CAD) over a time horizon from study entry to hospital discharge or death. We calculated the incremental net monetary benefit (iNMB) of the intervention group compared with the pre-intervention group. The primary outcome was cost per sepsis case. Secondary outcomes included readmission rates, Clostridioides difficile infections, mortality, and lengths of stay. Uncertainty was investigated using cost-effectiveness acceptability curves, cost-effectiveness plane scatterplots, and sensitivity analyses. Results Mean (standard deviation [SD]) cost per index hospital admission was CAD $83,251 ($107,926) for patients in the intervention group and CAD $87,044 ($104,406) for the pre-intervention group, though the difference ($3,793 [$7,897]) was not statistically significant. Costs were higher in the pre-intervention group for antibiotics, readmissions, and C. difficile infections. The intervention group had a lower mean expected cost; $110,580 ($108,917) compared with pre-intervention ($125,745 [$113,210]), with a difference of $15,165 ($8278). There were no statistically significant differences in quality adjusted life years (QALYs) between groups. The iNMB of the intervention group compared with pre-intervention was greater than $15,000 for willingness-to-pay (WTP) per QALY values of between $0 and $100,000. In our sensitivity analysis, the intervention was most likely to be cost-effective in roughly 56% of simulations at all WTP thresholds. Conclusions Our bundled intervention of ASP, PCT, and BCID among adult critically ill patients with sepsis was potentially cost-effective, but with substantial decision uncertainty.

Suggested Citation

  • Wendy I. Sligl & Charles Yan & Jeff Round & Xiaoming Wang & Justin Z. Chen & Cheyanne Boehm & Karen Fong & Katelynn Crick & Míriam Garrido Clua & Cassidy Codan & Tanis C. Dingle & Connie Prosser & Gua, 2025. "Health Economic Evaluation of Antimicrobial Stewardship, Procalcitonin Testing, and Rapid Blood Culture Identification in Sepsis Care: A 90-Day Model-Based, Cost-Utility Analysis," PharmacoEconomics - Open, Springer, vol. 9(1), pages 15-25, January.
    • Handle: RePEc:spr:pharmo:v:9:y:2025:i:1:d:10.1007_s41669-024-00538-y
    DOI: 10.1007/s41669-024-00538-y
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s41669-024-00538-y
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1007/s41669-024-00538-y?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Glick, Henry A. & Doshi, Jalpa A. & Sonnad, Seema S. & Polsky, Daniel, 2014. "Economic Evaluation in Clinical Trials," OUP Catalogue, Oxford University Press, edition 2, number 9780199685028.
    2. Jan-Willem H Dik & Ron Hendrix & Alex W Friedrich & Jos Luttjeboer & Prashant Nannan Panday & Kasper R Wilting & Jerome R Lo-Ten-Foe & Maarten J Postma & Bhanu Sinha, 2015. "Cost-Minimization Model of a Multidisciplinary Antibiotic Stewardship Team Based on a Successful Implementation on a Urology Ward of an Academic Hospital," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-12, May.
    3. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Osvaldo Ulises Garay & Marie Libérée Nishimwe & Marwân-al-Qays Bousmah & Asmaa Janah & Pierre-Marie Girard & Geneviève Chêne & Laetitia Moinot & Luis Sagaon-Teyssier & Jean-Luc Meynard & Bruno Spire &, 2019. "Cost-Effectiveness Analysis of Lopinavir/Ritonavir Monotherapy Versus Standard Combination Antiretroviral Therapy in HIV-1 Infected Patients with Viral Suppression in France (ANRS 140 DREAM)," PharmacoEconomics - Open, Springer, vol. 3(4), pages 505-515, December.
    2. Matthew Franklin & James Lomas & Simon Walker & Tracey Young, 2019. "An Educational Review About Using Cost Data for the Purpose of Cost-Effectiveness Analysis," PharmacoEconomics, Springer, vol. 37(5), pages 631-643, May.
    3. Marwân-al-Qays Bousmah & Marie Libérée Nishimwe & Tamara Tovar-Sanchez & Martial Lantche Wandji & Mireille Mpoudi-Etame & Gwenaëlle Maradan & Pierrette Omgba Bassega & Marie Varloteaux & Alice Montoyo, 2021. "Cost-Utility Analysis of a Dolutegravir-Based Versus Low-Dose Efavirenz-Based Regimen for the Initial Treatment of HIV-Infected Patients in Cameroon (NAMSAL ANRS 12313 Trial)," PharmacoEconomics, Springer, vol. 39(3), pages 331-343, March.
    4. Cochrane, M. & Watson, P.M. & Timpson, H. & Haycox, A. & Collins, B. & Jones, L. & Martin, A. & Graves, L.E.F., 2019. "Systematic review of the methods used in economic evaluations of targeted physical activity and sedentary behaviour interventions," Social Science & Medicine, Elsevier, vol. 232(C), pages 156-167.
    5. Jalal Dahham & Ingrid Kremer & Mickaël Hiligsmann & Kamal Hamdan & Abdallah Nassereddine & Silvia M. A. A. Evers & Rana Rizk, 2023. "Valuation of Costs in Health Economics During Financial and Economic Crises: A Case Study from Lebanon," Applied Health Economics and Health Policy, Springer, vol. 21(1), pages 31-38, January.
    6. Charles Yan & Jeff Round & Ilke Akpinar & Chantal E. Atwood & Lesly Deuchar & Mohit Bhutani & Richard Leigh & Michael K. Stickland, 2023. "Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial," PharmacoEconomics - Open, Springer, vol. 7(3), pages 493-505, May.
    7. Carlo Lazzaro & Cecile van Steen & Florent Aptel & Cedric Schweitzer & Luigi Angelillo, 2022. "Cost-Utility Analysis of STN1013001, a Latanoprost Cationic Emulsion, versus Other Latanoprost Formulations (Latanoprost) in Open-Angle Glaucoma or Ocular Hypertension and Ocular Surface Disease in Fr," Post-Print hal-03696350, HAL.
    8. Chiranjeev Sanyal & Don Husereau, 2020. "Systematic Review of Economic Evaluations of Services Provided by Community Pharmacists," Applied Health Economics and Health Policy, Springer, vol. 18(3), pages 375-392, June.
    9. Andrew J. Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin & Richard Cookson & Peter Berman, 2020. "Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 4, pages 99-132, World Scientific Publishing Co. Pte. Ltd..
    10. Christopher M Doran & Irina Kinchin, 2020. "Economic and epidemiological impact of youth suicide in countries with the highest human development index," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-11, May.
    11. Maria Rubio-Valera & María Teresa Peñarrubia-María & Maria Iglesias-González & Martin Knapp & Paul McCrone & Marta Roig & Ramón Sabes-Figuera & Juan V. Luciano & Juan M. Mendive & Ana Gabriela Murruga, 2019. "Cost-effectiveness of antidepressants versus active monitoring for mild-to-moderate major depressive disorder: a multisite non-randomized-controlled trial in primary care (INFAP study)," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(5), pages 703-713, July.
    12. José-Manuel Pastora-Bernal & María-José Estebanez-Pérez & Guadalupe Molina-Torres & Francisco-José García-López & Raquel Sobrino-Sánchez & Rocío Martín-Valero, 2021. "Telerehabilitation Intervention in Patients with COVID-19 after Hospital Discharge to Improve Functional Capacity and Quality of Life. Study Protocol for a Multicenter Randomized Clinical Trial," IJERPH, MDPI, vol. 18(6), pages 1-12, March.
    13. Qi Cao & Erik Buskens & Hans L. Hillege & Tiny Jaarsma & Maarten Postma & Douwe Postmus, 2019. "Stratified treatment recommendation or one-size-fits-all? A health economic insight based on graphical exploration," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 475-482, April.
    14. Dongzhe Hong & Lei Si & Minghuan Jiang & Hui Shao & Wai-kit Ming & Yingnan Zhao & Yan Li & Lizheng Shi, 2019. "Cost Effectiveness of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Dipeptidyl Peptidase-4 (DPP-4) Inhibitors: A Systematic Review," PharmacoEconomics, Springer, vol. 37(6), pages 777-818, June.
    15. Simon Pol & Paula Rojas Garcia & Fernando Antoñanzas Villar & Maarten J. Postma & Antoinette D. I. Asselt, 2021. "Health-Economic Analyses of Diagnostics: Guidance on Design and Reporting," PharmacoEconomics, Springer, vol. 39(12), pages 1355-1363, December.
    16. Paul Revill & Simon Walker & Valentina Cambiano & Andrew Phillips & Mark J Sculpher, 2018. "Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-13, January.
    17. Omar B. Da'ar & Abdi A. Gele, 2023. "Tuberculosis in a weak health system, conflict and fragile zone: The monetary value of human lives lost associated with deaths of persons older than 14 years in Somalia," International Journal of Health Planning and Management, Wiley Blackwell, vol. 38(1), pages 53-68, January.
    18. Anna Nicolet & Antoinette D I van Asselt & Karin M Vermeulen & Paul F M Krabbe, 2020. "Value judgment of new medical treatments: Societal and patient perspectives to inform priority setting in The Netherlands," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-18, July.
    19. McNamara, Simon & Tsuchiya, Aki & Holmes, John, 2021. "Does the UK-public's aversion to inequalities in health differ by group-labelling and health-gain type? A choice-experiment," Social Science & Medicine, Elsevier, vol. 269(C).
    20. Nikolai Mühlberger & Gaby Sroczynski & Artemisa Gogollari & Beate Jahn & Nora Pashayan & Ewout Steyerberg & Martin Widschwendter & Uwe Siebert, 2021. "Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(8), pages 1311-1344, November.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:pharmo:v:9:y:2025:i:1:d:10.1007_s41669-024-00538-y. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.