ECONOMIC EVALUATION OF PROCALCITONIN-GUIDED ANTIBIOTIC THERAPY IN ACUTE RESPIRATORY INFECTIONS: A CHILE HEALTH SYSTEM PERSPECTIVE

Mathematical models have indicated that, in the United States, the use of antibiotic stewardship protocols based on procalcitonin levels for patients with suspected acute respiratory tract infection (ARI) results in cost savings. Herein, our objective was to assess the economic impact of adopting procalcitonin (PCT) testing among patients with suspected (ARI) from the perspective of the public health system in Chile. To conduct an economic evaluation of PCT testing versus usual care, we built a cost-impact model based on patient-level meta-analysis data from randomized trials. The meta-analytic data was adapted to the Chilean setting by applying Chilean data to lengths of stay, costs, and practice patterns relevant to the treatment of ARI in Chile. We estimated the annual ARI visit rate for the public system healthcare members (about 13 million people), by clinical setting (inpatient, ICU, outpatient) and ARI diagnosis. In the inpatient setting, the costs of procalcitonin-guided compared to usual care for the Chilean public health system was $1.3 billion Chilean pesos (CLP), compared to $2 billion CLP, resulting in net savings of nearly $712 million CLP to the health system for 2015. In the ICU and outpatient settings, savings were $117 million CLP and $298 million CLP, respectively. Across all three settings, the overall net savings of PCT-guided care was $1.1 billion CLP (or approximately $1.6 million USD) for the Chilean population utilizing the public health system. Results were robust for all ARI diagnoses. Our results show substantial savings associated with PCT protocols for ARI across common Chile treatment settings mainly by direct reduction in unnecessary antibiotic utilization. These results are robust to changes in key parameters, and savings can be achieved without any negative impact on treatment outcomes.