Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings

Abstract

Bacterial sepsis is a leading cause of mortality among febrile patients in low- and middle-income countries, but blood culture services are not widely available. Consequently, empiric antimicrobial management of suspected bloodstream infection is based on generic guidelines that are rarely informed by local data on etiology and patterns of antimicrobial resistance. To evaluate the cost-effectiveness of surveillance for bloodstream infections to inform empiric management of suspected sepsis in low-resource areas, we compared costs and outcomes of generic antimicrobial management with management informed by local data on etiology and patterns of antimicrobial resistance. We applied a decision tree model to a hypothetical population of febrile patients presenting at the district hospital level in Africa. We found that the evidence-based regimen saved 534 more lives per 100,000 patients at an additional cost of $25.35 per patient, resulting in an incremental cost-effectiveness ratio of $4,739. This ratio compares favorably to standard cost-effectiveness thresholds, but should ultimately be compared with other policy-relevant alternatives to determine whether routine surveillance for bloodstream infections is a cost-effective strategy in the African context.

Figure 1.

Decision tree representing probabilities, costs, and outcomes for a febrile patient presenting at a district hospital in a low-resource setting and receiving either generic or evidence-based antimicrobial treatment using base case all of Africa data. Cost figures represent the total costs of tests and antimicrobial treatment. Probabilities of an event occurring are shown in in brackets. Probabilities are rounded to two decimal places.

Figure 2.

Incremental cost-effectiveness ratio of evidence-based antimicrobial treatment at differing levels of susceptibility compared with base-case generic antimicrobial treatment using all of Africa prevalence and susceptibility data. The vertical dotted line indicates the probability of susceptibility to evidence-based antimicrobials at which the incremental cost-effectiveness ratio falls below $5,000 per life saved.