Effect of Procalcitonin Testing on Healthcare Utilization and Costs in Critically Ill Patients in the United States.
Chest. 2016 Aug 25;
Authors: Balk RA, Bozzette SA, Cao Z, Kadri SS, Lipkin CB, Robinson SB
Abstract
BACKGROUND: There is a growing use of Procalcitonin (PCT) to facilitate the diagnosis and management of severe sepsis. We investigated the impact of 1-2 PCT determinations on ICU day 1 on healthcare utilization and cost in a large research database.
METHODS: A retrospective, propensity score matched multivariable analysis was performed on the Premier Healthcare Database for patients admitted to the ICU with 1-2 PCT evaluations on day 1 of ICU admission versus patients who did not have PCT testing.
RESULTS: 33,569 PCT managed patients were compared to 98,543 propensity-matched non-PCT patients. In multivariable regression analysis, PCT utilization was associated with significantly decreased total [11.6 days (95% CI 11.4-11.7 days) vs 12.7 days (95% CI 12.6-12.8 days); (95% CI for difference 1-1.3) p<0.001] and ICU length of stay [5.1 days (95% CI 5.1-5.2 days) vs 5.3 days (95% CI 5.3-5.4 days); (95% CI for difference 0.1- 0.3) p<0.03], and lower hospital costs [$30,454 (95% CI $29,968-$31,033) vs $33,213 (95% CI $32,964-$33,556); (95% CI for difference $2,159 - $3,321) p<0.001]. There was significantly less total antibiotic exposure [16.2 days (95% CI 16.1 -16.5 days) vs 16.9 days (95% CI 16.8-17.1 days) (95% CI for differences -0.9- -0.4 days) p=0.006] in PCT managed patients. Patients in the PCT group were more likely to be discharged to home [44.1% (95% CI 43.7%-44.6%) vs 41.3% (95% CI 41%-41.6%); 95% CI for difference 2.3 - 3.3) p=0.006]. Mortality was not different in an analysis including the 96% of patients that had an independent measure of mortality risk available [19.1% (95% CI 18.7%-19.4%) vs 19.1% (95% CI 18.9%-19.3%); 95% CI for difference -0.5%-0.4%) p=0.93].
CONCLUSIONS: Use of PCT testing on the first day of ICU admission was associated with significantly lower hospital and ICU length of stay, as well as decreased total, ICU, and pharmacy cost of care. Further elucidation of clinical outcomes requires additional data.
PMID: 27568580 [PubMed - as supplied by publisher]