Critical Care volume 29,
Article number: 352, Published: 08 August 2025
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.
