Rapid antibiotic susceptibility testing for urinary tract infections in secondary care in England: A cost-effectiveness analysis

Abstract

Objectives To perform a model-based cost-effectiveness evaluation of a rapid antimicrobial susceptibility test. Design A Markov model of a cohort of hospital inpatients with urinary tract infection (with inpatient numbers based on national administrative data from 1 April 2017 to 31 March 2019). Setting Urinary tract infections (UTI) in acute National Health Service (NHS) Trusts in England, from the perspective of the NHS Healthcare system, at a national level. Participants A simulated cohort of approximately 280 000 non-pregnant adult inpatients within secondary care with a clinical suspicion of UTI. Interventions Evaluation of the implementation of a fast bacterial impedance cytometry test (BICT) compared with current practice. Primary and secondary outcome measures Incremental cost, quality-Adjusted life years, net monetary benefit, and bed days and appropriateness of antibiotic use per patient. Costs are presented in 2022 GBP. Results Considering benefits arising from reduced time on inappropriate treatment, BICT gives an average net monetary benefit (NMB) over the simulation period of approximately £4.3 million and dominates culture methods (from the healthcare system perspective and with a willingness to pay threshold of £20 000 per quality-Adjusted life year). Total inappropriate prescribing days due to the BICT test are reduced by 57%. The extent of the benefit from BICT implementation was strongly dependent on prevalence of resistance, with the NMB increasing sevenfold to over £30 million in a high (40%) resistance prevalence scenario. At the population level, the patient groups with the highest cost and quality-Adjusted life year impacts were 65-100-year-old females, followed by males, with uncomplicated UTIs. At an individual patient level, however, 16-64-year-old females with complicated UTIs with oral treatment, followed by 65-100-year-old males with complicated UTIs with oral treatment, were impacted to the greatest degree by the rapid BICT. Conclusions Under conservative assumptions and for wide parameter sensitivity, the implementation of BICT would be cost-effective from the NHS healthcare system perspective.