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

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, Guanmin Chen, Alena Tse-Chang, Daniel Garros, David Zygun, Dawn Opgenorth, John M. Conly, Christopher J. Doig, Vincent I. Lau and Sean M. Bagshaw
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Wendy I. Sligl: University of Alberta and Alberta Health Services
Charles Yan: Institute of Health Economics
Jeff Round: Institute of Health Economics
Xiaoming Wang: Alberta Health Services
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
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
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

PharmacoEconomics - Open, 2025, vol. 9, issue 1, No 3, 15-25

Abstract: 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.

Date: 2025
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DOI: 10.1007/s41669-024-00538-y

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