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

doi:10.1186/s13054-021-03789-x

. 2021 Oct 20;25(1):367.

doi: 10.1186/s13054-021-03789-x.

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

A J L M Geraerds^#¹, Wendy van Herk^#², Martin Stocker³, Salhab El Helou⁴, Sourabh Dutta⁴, Matteo S Fontana³, Frank A B A Schuerman⁵, Rita K van den Tooren-de Groot⁶, Jantien Wieringa⁶, Jan Janota^{7

8}, Laura H van der Meer-Kappelle⁹, Rob Moonen¹⁰, Sintha D Sie¹¹, Esther de Vries¹², Albertine E Donker¹³, Urs Zimmerman¹⁴, Luregn J Schlapbach^{15

16

17}, Amerik C de Mol¹⁸, Angelique Hoffman-Haringsma¹⁹, Madan Roy²⁰, Maren Tomaske²¹, René F Kornelisse²², Juliette van Gijsel²³, Eline G Visser², Annemarie M C van Rossum², Suzanne Polinder²⁴

Affiliations

¹ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. a.geraerds@erasmusmc.nl.
² Division of Paediatric Infectious Diseases & Immunology, Department of Paediatrics, Erasmus MC University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.
³ Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland.
⁴ Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada.
⁵ Neonatal Intensive Care Unit, Isala Women and Children's Centre, Isala Hospital, Zwolle, The Netherlands.
⁶ Department of Paediatrics, Haaglanden Medical Center, 's Gravenhage, The Netherlands.
⁷ Neonatal Unit, Department of Obstetrics and Gynaecology, Motol University Hospital, Second Medical Faculty, Charles University, Prague, Czech Republic.
⁸ Institute of Pathological Physiology, First Medical Faculty, Charles University, Prague, Czech Republic.
⁹ Department of Neonatology, Reinier de Graaf Gasthuis, Delft, The Netherlands.
¹⁰ Department of Neonatology, Zuyderland Medical Centre, Heerlen, The Netherlands.
¹¹ Department of Neonatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹² Department of Paediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
¹³ Department of Paediatrics, Maxima Medical Centre, Veldhoven, The Netherlands.
¹⁴ Department of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland.
¹⁵ Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
¹⁶ Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.
¹⁷ Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.
¹⁸ Department of Neonatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
¹⁹ Department of Neonatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
²⁰ Department of Neonatology, St. Josephs Healthcare, Hamilton Health Sciences, Hamilton, ON, Canada.
²¹ Department of Paediatrics, Stadtspital Triemli, Zürich, Switzerland.
²² Division of Neonatology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
²³ Julius Training General Practitioner, University Medical Centre Utrecht, Utrecht, The Netherlands.
²⁴ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.

^# Contributed equally.

PMID: 34670582
PMCID: PMC8529813
DOI: 10.1186/s13054-021-03789-x

Free PMC article

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

A J L M Geraerds et al. Crit Care. 2021.

Free PMC article

. 2021 Oct 20;25(1):367.

doi: 10.1186/s13054-021-03789-x.

Authors

Affiliations

¹ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. a.geraerds@erasmusmc.nl.
² Division of Paediatric Infectious Diseases & Immunology, Department of Paediatrics, Erasmus MC University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.
³ Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland.
⁴ Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada.
⁵ Neonatal Intensive Care Unit, Isala Women and Children's Centre, Isala Hospital, Zwolle, The Netherlands.
⁶ Department of Paediatrics, Haaglanden Medical Center, 's Gravenhage, The Netherlands.
⁷ Neonatal Unit, Department of Obstetrics and Gynaecology, Motol University Hospital, Second Medical Faculty, Charles University, Prague, Czech Republic.
⁸ Institute of Pathological Physiology, First Medical Faculty, Charles University, Prague, Czech Republic.
⁹ Department of Neonatology, Reinier de Graaf Gasthuis, Delft, The Netherlands.
¹⁰ Department of Neonatology, Zuyderland Medical Centre, Heerlen, The Netherlands.
¹¹ Department of Neonatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹² Department of Paediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
¹³ Department of Paediatrics, Maxima Medical Centre, Veldhoven, The Netherlands.
¹⁴ Department of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland.
¹⁵ Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
¹⁶ Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.
¹⁷ Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.
¹⁸ Department of Neonatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
¹⁹ Department of Neonatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
²⁰ Department of Neonatology, St. Josephs Healthcare, Hamilton Health Sciences, Hamilton, ON, Canada.
²¹ Department of Paediatrics, Stadtspital Triemli, Zürich, Switzerland.
²² Division of Neonatology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
²³ Julius Training General Practitioner, University Medical Centre Utrecht, Utrecht, The Netherlands.
²⁴ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.

^# Contributed equally.

PMID: 34670582
PMCID: PMC8529813
DOI: 10.1186/s13054-021-03789-x

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.

Keywords: Costs; Neonates; Procalcitonin-guided decision making; Sepsis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Flowchart. *Unknown are neonates with missing key variables

**Fig. 2**
Composition of total health care costs for PCT-guided decision making and standard care for subgroups. *PCT* Procalcitonin-guided decision-making group. SC Standard care group. *Other includes costs of laboratory tests and costs of labor

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References

1. Vergnano S, Menson E, Kennea N, Embleton N, Russell AB, Watts T, et al. Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed. 2011;96(1):F9–F14. doi: 10.1136/adc.2009.178798. - DOI - PubMed
1. Zimmermann P, Curtis N. Effect of intrapartum antibiotics on the intestinal microbiota of infants: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2020;105(2):201–208. doi: 10.1136/archdischild-2018-316659. - DOI - PubMed
1. Afroza S. Neonatal sepsis—a global problem: an overview. Mymensingh Med J. 2006;15(1):108–114. - PubMed
1. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341(8844):515–518. doi: 10.1016/0140-6736(93)90277-N. - DOI - PMC - PubMed
1. van Rossum AM, Wulkan RW, Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis. 2004;4(10):620–630. doi: 10.1016/S1473-3099(04)01146-6. - DOI - PubMed

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[1] Vergnano S, Menson E, Kennea N, Embleton N, Russell AB, Watts T, et al. Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed. 2011;96(1):F9–F14. doi: 10.1136/adc.2009.178798. - DOI - PubMed

[2] Vergnano S, Menson E, Kennea N, Embleton N, Russell AB, Watts T, et al. Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed. 2011;96(1):F9–F14. doi: 10.1136/adc.2009.178798. - DOI - PubMed

[3] Zimmermann P, Curtis N. Effect of intrapartum antibiotics on the intestinal microbiota of infants: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2020;105(2):201–208. doi: 10.1136/archdischild-2018-316659. - DOI - PubMed

[4] Zimmermann P, Curtis N. Effect of intrapartum antibiotics on the intestinal microbiota of infants: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2020;105(2):201–208. doi: 10.1136/archdischild-2018-316659. - DOI - PubMed

[5] Afroza S. Neonatal sepsis—a global problem: an overview. Mymensingh Med J. 2006;15(1):108–114. - PubMed

[6] Afroza S. Neonatal sepsis—a global problem: an overview. Mymensingh Med J. 2006;15(1):108–114. - PubMed

[7] Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341(8844):515–518. doi: 10.1016/0140-6736(93)90277-N. - DOI - PMC - PubMed

[8] Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341(8844):515–518. doi: 10.1016/0140-6736(93)90277-N. - DOI - PMC - PubMed

[9] van Rossum AM, Wulkan RW, Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis. 2004;4(10):620–630. doi: 10.1016/S1473-3099(04)01146-6. - DOI - PubMed

[10] van Rossum AM, Wulkan RW, Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis. 2004;4(10):620–630. doi: 10.1016/S1473-3099(04)01146-6. - DOI - PubMed

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

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

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