Article
Author: Richman, Colin ; Darke, Emma ; Dunn, Leigh ; Williams, Sarah ; Berry, Claire ; Plowright, Megan ; Newman, Thomas ; Hopkins, Susan ; Mackay, Ruaridh ; Spencer, Joseph ; Sandoe, Jonathan ; King, Charlie ; Hammonds, Fiona ; Henley, Josie ; McCullagh, Iain ; Murphy, Hannah ; Howard, Lucy ; Brookes-Howell, Lucy ; Simoes, Fatima ; Albur, Mahableshwar ; Kirkpatrick, Jennifer ; Fletcher, Eve ; Hellyer, Thomas ; Sultan, Saheer ; Baker, Evelyn ; Grozeva, Detelina ; Tai, Yuen Kiu ; Dunhill, Jill ; Westacott, Clare ; Cross, Elizabeth ; Dark, Paul ; Ayliffe, Freddie ; Cawthron, Kay ; Welch, Leanne ; Williams, Lisa ; Sweeney, Graham ; Brodsky, Mary ; Harvey, Alice ; Joseph, Amelia ; Nash, Maxine ; Maboshe, Wakunyambo ; Small, Claire ; Brown, Benjamin ; DeSousa, Jessica ; Shulver, Helen ; Partridge, David ; Howard, Philip ; Issac, Elizabeth ; Pallmann, Philip ; Hope, Russell ; Walker, Danielle ; Bond, Stuart ; Webb, Edward J D ; Lomas, Diane ; Apatri, Elena ; Marquez, Gladys ; Davis, Georgina ; Burns, Jenni ; Sivakova, Anna ; Shaw, Dominick ; Kooner, Simran ; Gerver, Sarah ; West, Robert ; Scanlon, Deborah ; Wilkinson, Vikki ; Bestwick, Rebecca ; Powell, Neil ; Lee-Milner, Jade ; Carrol, Enitan ; King, Natalie ; Todd, Stacy ; Taylor-Barr, Eleanor ; Webb, Edward ; Killick, Charlotte ; Euden, Joanne ; Howdon, Daniel ; Taylor, Melanie ; Sandoe, Jonathan A T ; Howard, Megan ; Szakmany, Tamas ; Hamilton, Ryan ; Calabrese, Michele ; Charles, Bethan ; Bargiel, Marcin ; Glynn, Sharon ; Carrol, Enitan D ; Gulati, Arti ; Richardson, Owen ; Grieveson, Stephanie ; Evans, Judith ; Hansen, Daniel ; Richardson, Emma ; Llewelyn, Martin ; Thomas-Jones, Emma ; Brandao, Rodrigo ; Thomas, Vicky ; Cheema, Yusuf ; Tuffney, Jemma ; Stanley, Jack ; Cole, Cameron ; Christensen, Helen ; Brown, Jo ; Lewis, Swyn ; McCullagh, Iain J ; Hellyer, Tom ; Whyte, Abigail ; Gureviciute, Alvyda ; Heginbothom, Margaret ; Ogden, Margaret ; Parsons, Helena ; Knox-Macaulay, Chikezie ; Hrycaiczuk, Joshua ; Prestwich, Graham ; Redmore, Ethan ; Shinkins, Bethany
AbstractBackgroundMany 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.ObjectivesEvaluating cost-effectiveness of using PCT to guide antibiotic decisions in individuals hospitalized with COVID-19, as part of a wider research programme.MethodsRetrospective 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.ResultsPeople 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.ConclusionsUsing PCT to guide antibiotic therapy in individuals hospitalized with COVID-19 is more likely to be cost-effective than not, albeit with uncertainty.