Cost-effectiveness of rapid, ICU-based, syndromic PCR in hospital-acquired pneumonia: analysis of the INHALE WP3 multi-centre RCT

Wagner, Adam P., Enne, Virve, Gant, Vanya, Stirling, Susan, Barber, Julie A., Livermore, David M. and Turner, David A. and INHALE WP3 study group (2025) Cost-effectiveness of rapid, ICU-based, syndromic PCR in hospital-acquired pneumonia: analysis of the INHALE WP3 multi-centre RCT. Critical Care, 29. ISSN 1364-8535

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Abstract

Background: Hospital-acquired and ventilator-associated pneumonia (HAP and VAP) are pneumonias arising > 48 h after admission or intubation respectively. Conventionally, HAP/VAP patients are given broad-spectrum empiric antibiotics at clinical diagnosis, refined after 48–72 h, once microbiology results become available. Molecular tests offer swifter results, potentially improving patient care. To investigate whether this potential is realisable, we conducted a pragmatic multi-centre RCT (‘INHALE WP3’) of rapid, syndromic polymerase chain reaction (PCR) in ICU HAP/VAP compared with standard of care. As the use of molecular tests impact on hospital resources, it is important to consider their potential value-for-money to make fully informed decisions. Consequently, INHALE WP3 included an economic evaluation, presented here. Its aim was to estimate the cost-effectiveness of an in-ICU PCR (bioMérieux BioFire FilmArray Pneumonia Panel) in HAP/VAP, informing whether to implement such technology in routine NHS care. Methods: We collected data on patient resource use and costs. These data were combined with INHALE WP3’s two primary outcome measures: antibiotic stewardship at 24 h and clinical cure at 14 days. Cost-effectiveness analyses were carried out using regression models adjusting for site. Sensitivity analyses explored assumptions and sub-group analyses explored differential impacts. Results: We found lower total ICU costs (including PCR costs) in the intervention (PCR-guided therapy) group. Average costs were £40,951 for standard of care compared with £33,149 for the intervention group, a difference of − £7,802 (95% CI: − £15,696, £92). For antibiotic stewardship, the PCR-guided therapy was both less costly and more effective than routine patient management. For clinical cure, we did not find PCR-guided therapy to be cost-effective due to fewer cases being cured in the intervention group. Conclusions: We found lower average ICU costs with the Pneumonia Panel. The pneumonia panel was cost-effective in terms of antibiotic stewardship, but not clinical cure. Trial registration: Registered as ISRCTN16483855 on 5th August 2019.

Item Type:	Article
Additional Information:	Availability of data and materials: The data dictionary and de-identified patient data analysed and presented in this study are available from NCTU following publication, on reasonable request and subject to appropriate data sharing agreements. The health economics analysis plan is publicly available at https://norwichcrtu.uea.ac.uk/ctudocs_public/inhale/heap_1_4.pdf. Funding information: This research was funding by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (Reference number: RP-PG-0514-20018). APW (and the University of East Anglia) was additionally supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East of England (NIHR ARC EoE) at Cambridgeshire and Peterborough NHS Foundation Trust. JB was additionally supported by the UCLH NIHR Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Groups > Health Economics Faculty of Medicine and Health Sciences > Research Centres > Population Health (former - to 2025) Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Centres > Public Health
Depositing User:	LivePure Connector
Date Deposited:	24 Apr 2025 16:30
Last Modified:	17 Aug 2025 06:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/99088
DOI:	10.1186/s13054-025-05428-1

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