BACKGROUND Two clinical studies suggest that procalcitonin-guided antibiotic therapy can safely reduce antibiotic prescribing in outpatient management of acute respiratory tract infections (ARTIs) in adults. reflecting the estimated cost of antibiotic resistance per outpatient 501925-31-1 antibiotic prescribed. In the cohort including all adult ARTIs judged to require antibiotics by their physicians, procalcitonin cost $31 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored compared to usual care was 58.4 % 501925-31-1 in a probabilistic sensitivity analysis. In the analysis that included all adult ARTIs, procalcitonin cost $149 per antibiotic prescription safely avoided and the likelihood of procalcitonin 501925-31-1 501925-31-1 use being favored was 2.8 %. CONCLUSIONS Procalcitonin-guided antibiotic therapy for outpatient management of ARTIs in adults would be cost-effective when the costs of antibiotic resistance are considered and procalcitonin screening is limited to adults with ARTIs judged by their physicians to require antibiotics. KEY Terms: procalcitonin, antibiotics, respiratory tract infection, cost-effectiveness INTRODUCTION Acute respiratory tract infections (ARTIs) account for 10 501925-31-1 %10 % of all ambulatory visits and 44 % of all antibiotic prescriptions in the United States.1 Despite the predominant viral etiology of most ARTIs, antibiotics are prescribed in > 50 % of such infections and an increasing proportion of these are broad-spectrum brokers.1C5 Excessive antibiotic use for ARTIs is concerning, because there is little evidence of individual patient benefit from such therapy and strong evidence of increased antibiotic resistance and healthcare costs.6C10 With increasing antibiotic resistance and few new agents under development, antibiotic stewardship has become a national health priority.11 A number of interventions to reduce unnecessary antibiotic prescribing have been evaluated, including media campaigns, physician education, practice guidelines, chart reminders and audit and feedback systems.12,13 The modest effectiveness of the strategies, however, lead the writers of a recently available Cochrane review to summarize these interventions are unlikely to result in a decrease in the incidence of antibiotic-resistant bacterias leading to community-acquired infection.12 The disappointing impact of such interventions on antibiotic prescribing is responsible partly for an evergrowing curiosity about the usage of lab exams to detect serum inflammatory markers such as for example C-reactive proteins (CRP) and procalcitonin to steer antibiotic decision-making in the administration of ARTIs. While CRP continues to be used to identify community-acquired pneumonia and differentiate between bacterial and viral etiologies in lower respiratory system infections, this check is suffering from suboptimal awareness and specificity and when applied clinically, it does not appear to reduce antibiotic prescribing compared to existing decision support algorithms.14,15 More recently, procalcitonin has emerged as a encouraging alternative for guiding antibiotic therapy, because this serum marker is elevated in bacterial infections, but not in viral infections or non-specific inflammatory reactions.16 Procalcitonin has been studied in ambulatory and emergency department settings for guiding antibiotic therapy in adults with ARTIs and been found to reduce antibiotic use and treatment duration without increasing morbidity or mortality.16 Two randomized controlled trials (RCTs) have investigated the use of procalcitonin to guide management of ARTIs in the outpatient setting and found that procalcitonin use was associated with 15C72 % absolute reductions in antibiotic exposure without changes in safety endpoints.17,18 While procalcitonin-guided antibiotic therapy for adults with ARTIs managed in the outpatient setting is supported by clinical trials, the cost-effectiveness of this approach remains unclear. Our study aims to evaluate the cost-effectiveness of procalcitonin-guided antibiotic therapy in this setting. METHODS Model Perspective and Cohort To evaluate the cost-effectiveness of procalcitonin screening in adults with ARTIs managed in the outpatient setting, we developed a decision analysis model using TreeAge Pro 2009 software (TreeAge Software, Inc., Williamstown, MA). We assumed a ongoing health care system perspective and used an ARTI treatment episode as our period horizon. Because data Mouse monoclonal to PTH1R can be found from two Western european randomized controlled studies (RCTs) analyzing the basic safety and efficiency of procalcitonin examining in adults with ARTIs managed in the outpatient placing, we performed two different analyses using cohorts from each trial.17,18 The first cohort (Briel et al. 2008) included all adults delivering for an outpatient clinic.