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Original Research |

Effect of Procalcitonin Testing on Healthcare Utilization and Costs in Critically Ill Patients in the United States

Robert A. Balk, MD; Sameer S. Kadri, MD, MS; Zhun Cao, PhD; Scott B. Robinson, MA, MPH; Craig Lipkin, MS; Samuel A. Bozzette, MD, PhD
Author and Funding Information

aJ. Bailey Carter, MD Professor of Medicine, Director – Division of Pulmonary and Critical Care Medicine, Rush Medical College and Rush University Medical Center, 1725 West Harrison St. Suite 054, Chicago, IL 60612

bStaff Clinician, Critical Care Medicine Department, National Institutes of Health Clinical Center, 10 Center Dr. Bldg. 10, #2C145, Bethesda, MD 20892

cPrincipal Research Scientist, Premier Research Services, Inc., 13034 Ballantyne Corp. Pl, Charlotte, N.C. 28277

dPrincipal, Applied Research, Premier Research Services, Inc., 13034 Ballantyne Corp. Pl, Charlotte, N.C. 28277

eSenior Research Analyst, Premier Research Services, Inc., 13034 Ballantyne Corp. Pl, Charlotte, N.C. 28277

fVice President, Medical Affairs – Americas/East Asia and Global Health Economics and Outcomes, bioMérieux, Inc., Durham, N.C

gAdjunct Professor of Medicine and of International Relations, University of California, San Diego, CA

hAdjunct Professor of Health Policy and Management, University of North Carolina, Raleigh, N.C

Address correspondence to: Robert A. Balk, MD, Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, 1725 West Harrison St. Suite 054, Chicago, IL 60612.


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.06.046
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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.


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