Performance Requirements to Achieve Cost-Effectiveness of Point-of-Care Tests for Sepsis Among Patients with Febrile Illness in Low-Resource Settings
Year: 2015
Type: article
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.
Authors: Erin C. Penno, John A. Crump, Sarah J. Baird
Institutions: George Washington University, University of Otago
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Social, Economic and Environmental Drivers of Zoonoses in Tanzania (SEEDZ), G1886633764, G3028693477, G3168060087, G3204045353, The impact and social ecology of bacterial zoonoses in northern Tanzania, G5156098791, The Impact and Society Ecology of Bacterial Zoonoses in Northern Tanzania: Under, G5443035086, Molecular epidemiology of brucellosis in northern Tanzania
OpenAlex ID: W2273381860