Misuse of procalcitonin (PCT) testing protocols wasted 30% of laboratory budget in a tertiary hospital

Accurate and timely diagnosis of sepsis is critical for patient outcomes, with procalcitonin (PCT) serving as a key biomarker to guide antibiotic therapy and reduce unnecessary antibiotic exposure. Despite established protocols for PCT testing, adherence remains a challenge, leading to both suboptimal patient management and significant economic burden. Inappropriate testing, such as too-frequent measurements or lack of follow-up on initial results, can inflate healthcare costs without improving clinical utility, undermining antibiotic stewardship efforts and straining laboratory resources.

Researchers conducted a retrospective analysis of all procalcitonin (PCT) tests requested in a single tertiary hospital between January 2022 and December 2023. The study evaluated compliance with testing protocols by assessing the time intervals between consecutive PCT measurements. A standardized cost of €20/test was applied to calculate the economic impact of tests deemed unnecessary or inappropriate based on protocol deviations. The primary endpoint was the total cost of misused tests, identified by intervals shorter than 24 hours or lack of follow-up for initial results.

Over the two-year period, a total of 5,420 PCT tests were requested, incurring a total budget expenditure of €108,400. Analysis revealed significant protocol non-adherence, with almost 22% of tests conducted within 12 hours of the initial measurement, and 6% performed more than 10 days apart. These inappropriate tests alone accounted for €33,580, representing 30% of the total PCT testing budget. Additionally, 845 patients did not receive a follow-up PCT test after an initial measurement, leading to an expenditure of €16,900 in these cases. The median number of PCT tests per patient was 3.33. In 23 specific cases, more than 10 PCT tests were performed per patient, totaling 338 tests and costing €6,760. These findings highlight substantial financial inefficiencies.

Out of the €108,400 spent on PCT tests, at least €33,580 (30%) could have been saved by adhering to basic protocols, specifically by ensuring intervals longer than 24 hours between measurements and appropriate follow-up of initially elevated results.