This economic evaluation investigates the cost-effectiveness of a daily procalcitonin (PCT)-guided protocol to guide the duration of antibiotic treatment in adult patients with sepsis. Two analyses were conducted, the first estimating the cost per quality-adjusted life year (QALY) of the ADAPT-Sepsis study, which recruited 2760 patients randomized to a daily PCT-guided protocol, a daily C-reactive protein-guided protocol and standard care. The second analysis used meta-analyzed results from ADAPT-Sepsis and other PCT-guided treatment studies and employed a lifetime horizon. Key outcomes were the incremental costs and QALYs gained from using the daily PCT-guided protocol approach compared with standard care. Cost-effectiveness results were driven by the assumed impact of PCT testing on mortality although the confidence/credible intervals for ADAPT-Sepsis and the meta-analyzed data both included no effect. Within ADAPT-Sepsis, the use of PCT tests cost €427 more per patient and was associated with a small QALY loss (0.001), which suggests the daily PCT-guided protocol is dominated. This economic analysis has shown that a PCT-guided protocol to guide the duration of antibiotic treatment could be cost-effective.

This analysis assessed the cost effectiveness of ATM-AVI ± metronidazole versus colistin + meropenem (COL + MER) for the treatment of patients with complicated intra-abdominal infection and hospital-acquired pneumonia/ventilator-associated pneumonia, including infections with suspected metallo-β-lactamase-producing Enterobacterales from the public payer perspective in Italy using phase III trial data. The cost-effectiveness analysis adopted a decision tree model to simulate the clinical pathway of complicated intra-abdominal infection and hospital-acquired pneumonia/ventilator-associated pneumonia, followed by a Markov model to capture lifetime health outcomes on cured patients, with costs valued in 2024 Euros and discounted at 3%. The ATM-AVI treatment sequence (ATM-AVI ± metronidazole followed by cefiderocol after treatment failure) had improved clinical outcomes and higher cure rates, shorter hospital stays and higher quality-adjusted life-year gains compared with the COL + MER sequence (COL + MER followed by cefiderocol after treatment failure). The incremental cost-effectiveness ratio in the ATM-AVI sequence was dominant for complicated intra-abdominal infection and was €1552 per quality-adjusted life-year for hospital-acquired pneumonia/ventilator-associated pneumonia, well below the willingness-to-pay threshold of €30,000 in Italy. This analysis suggests that ATM-AVI is expected to be a cost-effective use of Italian healthcare resources for treating suspected metallo-β-lactamase-producing Enterobacterales, including complicated intra-abdominal infection and hospital-acquired pneumonia/ventilator-associated pneumonia.

The consumption of antibiotics in obstetric intensive care represents a major challenge, combining the need for effective treatment of severe maternal infections with the imperative to control costs and combat antibiotic resistance. This study aims to evaluate the direct cost of antibiotic therapy and analyse consumption profiles in an obstetric intensive care unit in Morocco. A retrospective, descriptive, single-centre study was conducted over 12 months (January-December 2024) in the obstetric intensive care unit of the CHU Ibn Rochd of Casablanca. All patients (n = 378) who received antibiotic therapy were included. Antibiotic consumption was quantified in Defined Daily Dose (DDD) per 1000 hospitalization days (HD). The economic analysis focused on the direct cost of antibiotics, based on hospital unit prices, with conversion into euros. The total annual cost of antibiotics amounted to 38,650 e, with an average cost of 102.25 e per patient. Healthcare-associated infections (HAIs) accounted for 67.9% of the total cost, with an additional cost of 13,819 e compared to community infections. Total consumption was 1,383.7 DDD/1000 HD, dominated by beta-lactams (618.6 DDD/1000 HD). The incidence of HAIs was 30.7%, with the main sites being bacteraemia (27.9%) and urinary tract infections (27.4%). The predominant pathogens were E. coli for urinary infections, P. aeruginosa and A. baumannii for pneumonias. The cost of antibiotics in obstetric intensive care is considerable, mainly driven by the management of healthcare-associated infections. Optimizing practices through antibiotic stewardship programs and strengthening HAI prevention measures is essential to control expenses and preserve the effectiveness of these vital therapies.