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Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings
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.
Author Notes
Financial support: This research was supported by a Strategic Development Award of the Department of Preventive and Social Medicine, University of Otago. JAC 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. Sarah J. Baird, Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, E-mail: sbaird@gwu.edu. John A. Crump, Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand, E-mail: john.crump@otago.ac.nz.