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Performance Requirements to Achieve Cost-Effectiveness of Point-of-Care Tests for Sepsis Among Patients with Febrile Illness in Low-Resource Settings
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.
Author Notes
Financial support: This research was supported by a Strategic Development Award of the Department of Preventive and Social Medicine, University of Otago. J. A. C is supported by the joint U.S. National Institutes of Health-National Science Foundation Ecology and Evolution of Infectious Disease program (R01 TW009237) and the UK Biotechnology and Biological Sciences Research Council (BBSRC) (BB/J010367/1), and by UK BBSRC Zoonoses in Emerging Livestock Systems awards BB/L017679, BB/L018926, and BB/L018845.
Authors' addresses: Erin C. Penno, Department of Preventive and Social Medicine, Centre for Health Systems, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand, E-mail: erin.penno@otago.ac.nz. John A. Crump, Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand, E-mail: john.crump@otago.ac.nz. Sarah J. Baird, Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, E-mail: sbaird@gwu.edu.