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The Clinical and Economic Value of Incorporating Monocyte Distribution Width Testing in the Detection of Occult
Lopamudra Das1, Melissa Naiman1, Jeff Radcliff1
1Beckman Coulter, Inc., Brea, California.
Background:
Sepsis is a leading cause of morbidity, mortality, and increased healthcare costs. Early recognition is critical, yet occult sepsis often evades standard screening, delaying care and worsening outcomes. Monocyte distribution width (MDW), a novel blood biomarker automatically reported with a routine complete blood cell count (CBC), has emerged as a promising tool for early detection of occult sepsis in adult patients in the emergency department (ED).
Objectives:
To evaluate the clinical and economic impact of incorporating MDW into standard ED sepsis screening vs standard of care (SoC).
Methods:
This study utilized a cost-consequence model to evaluate the clinical and economic impact of incorporating MDW into standard ED sepsis screening compared with standard screening (SoC) alone. Adults presenting to the ED and meeting sepsis criteria within 24 hours of CBC collection were stratified by sepsis suspicion level (no, low, high) and MDW values (normal, elevated). Outcomes, including time-to-antibiotics, hospital and intensive care unit (ICU) length of stay (LOS), ICU admission, mortality, and readmissions, were estimated using trial data and regression models from published literature. Costs were assessed from a US provider perspective in 2024 US dollars.
Results:
In the base case, SoC + MDW testing was associated with lower costs per patient than SoC ( 37 703; savings of $1363). Savings were driven by reduced ward and ICU LOS, particularly among patients with no or low suspicion of sepsis (eg, ICU LOS 0.30 vs 0.44 days; ward LOS 2.22 vs 2.75 days). Mortality was also reduced (0.03 vs 0.06 deaths per patient). While ED LOS increased in the MDW arm, inpatient savings offset these costs. Scenario analyses confirmed greater savings when unadjusted time-to-antibiotic data were applied. These findings are consistent with prior economic evaluations of early sepsis diagnostic tools and support the role of MDW in reducing downstream resource utilization, particularly among patients with occult presentations.
Conclusions:
MDW was found to be a low-cost tool that can strengthen sepsis screening by flagging cases earlier, especially in occult sepsis. Because it is reported with a routine CBC, MDW can be readily implemented and may improve outcomes while reducing costs.
Insights
Monocyte distribution width (MDW) testing aids early sepsis detection, reducing costs and improving patient outcomes. This novel biomarker, integrated with routine blood tests, offers significant savings by shortening hospital stays and lowering mortality rates.
Area of Science:
- Clinical diagnostics
- Biomarker research
- Health economics
Background:
- Sepsis is a major cause of mortality and increased healthcare expenditure.
- Early sepsis detection is critical but challenging, especially for occult cases.
- Monocyte distribution width (MDW) is a novel biomarker for early sepsis detection in emergency departments.
Purpose of the Study:
- To evaluate the clinical and economic impact of integrating MDW into emergency department (ED) sepsis screening.
- To compare MDW-inclusive screening with standard of care (SoC) alone.
Main Methods:
- A cost-consequence model was used to assess clinical and economic outcomes.
- Adult ED patients meeting sepsis criteria were stratified by sepsis suspicion and MDW levels.
- Outcomes (time-to-antibiotics, LOS, mortality) and costs were estimated using published data and regression models.
Main Results:
- MDW testing alongside SoC resulted in lower costs per patient ($1363 savings) compared to SoC alone.
- Savings were driven by reduced intensive care unit (ICU) and ward length of stay (LOS).
- Mortality rates were reduced with MDW testing (0.03 vs 0.06 deaths per patient).
Conclusions:
- MDW is a cost-effective tool that enhances sepsis screening, particularly for occult cases.
- Readily implementable with routine complete blood counts (CBCs), MDW can improve outcomes and reduce healthcare costs.
- MDW supports reduced downstream resource utilization, especially in patients with subtle sepsis presentations.
