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Performance Requirements to Achieve Cost-Effectiveness of Point-of-Care Tests for Sepsis Among Patients with Febrile
Erin C Penno1, John A Crump1, Sarah J Baird2
1Department of Preventive and Social Medicine, Centre for Health Systems, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Centre for International Health, University of Otago, Dunedin, New Zealand; Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Insights
Developing a point-of-care test (POCT) for bacterial sepsis in low-resource settings can improve antimicrobial stewardship. A POCT with high accuracy, similar to malaria rapid diagnostic tests, is cost-effective and improves patient outcomes.
Area of Science:
- Infectious Diseases
- Health Economics
- Medical Diagnostics
Background:
- Bacterial sepsis significantly contributes to mortality in low- and middle-income countries.
- Accurate diagnosis of sepsis is challenging, impacting appropriate antimicrobial use.
- Current sepsis management relies on clinical assessments, which have limitations.
Purpose of the Study:
- To determine the minimum performance characteristics for a cost-effective point-of-care test (POCT) for sepsis.
- To evaluate the cost-effectiveness of a hypothetical sepsis POCT compared to clinical assessment.
- To assess the impact of POCT accuracy on patient survival and healthcare costs in resource-limited settings.
Main Methods:
- A decision tree model was applied to a hypothetical population of febrile patients in a low-resource district hospital.
- Performance characteristics of a hypothetical sepsis POCT were varied to assess cost-effectiveness.
- Case fatality probabilities were defined for appropriately (20%) and inappropriately (50%) treated sepsis.
Main Results:
- A sepsis POCT with 0.83 sensitivity and 0.94 specificity was found to be cost-effective compared to clinical assessment (0.83 sensitivity, 0.62 specificity).
- The cost-effective POCT resulted in equivalent survival rates at a lower cost of $1.14 per life saved.
- A POCT with accuracy comparable to leading malaria rapid diagnostic tests was both cheaper and more effective than clinical assessment.
Conclusions:
- Point-of-care tests for sepsis can be a valuable tool for improving diagnosis and antimicrobial stewardship in resource-limited settings.
- Sepsis POCTs with high specificity and sensitivity offer a cost-effective alternative to clinical assessment, enhancing patient survival.
- The development and implementation of accurate sepsis POCTs are crucial for reducing mortality and optimizing healthcare resource allocation in vulnerable populations.
Abstract:
Bacterial sepsis is an important cause of mortality in low- and middle-income countries, yet distinguishing patients with sepsis from those with other illnesses remains a challenge. Currently, management decisions are based on clinical assessment using algorithms such as Integrated Management of Adolescent and Adult Illness. Efforts to develop and evaluate point-of-care tests (POCTs) for sepsis to guide decisions on the use of antimicrobials are underway. To establish the minimum performance characteristics of such a test, we varied the characteristics of a hypothetical POCT for sepsis required for it to be cost-effective and applied a decision tree model to a population of febrile patients presenting at the district hospital level in a low-resource setting. We used a case fatality probability of 20% for appropriately treated sepsis and of 50% for inappropriately treated sepsis. On the basis of clinical assessment for sepsis with established sensitivity of 0.83 and specificity of 0.62, we found that a POCT for sepsis with a sensitivity of 0.83 and a specificity of 0.94 was cost-effective, resulting in parity in survival but costing $1.14 less per live saved. A POCT with accuracy equivalent to the best malaria rapid diagnostic test was cheaper and more effective than clinical assessment.
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