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Diagnostic Performance and Cost-Effectiveness of BALF mNGS in Older Adults with Pulmonary Infections

Year: 2026

Type: article

Abstract: Pulmonary infections in elderly patients cause high morbidity and mortality. Conventional culture has low sensitivity and slow turnaround, delaying targeted therapy. Metagenomic next-generation sequencing (mNGS) is an emerging technology, but its diagnostic performance and cost-effectiveness are unclear. This study therefore aims to evaluate its diagnostic performance compared to conventional culture in older adults with pulmonary infections and to assess its cost-effectiveness. From March 2020 to March 2023, 522 patients (aged 55–69 years) diagnosed with pulmonary infections were enrolled at Peking University Shenzhen Hospital. Of these, 168 patients underwent simultaneous mNGS and conventional culture testing using bronchoalveolar lavage fluid (BALF) samples, while the remaining 354 patients received culture testing alone. Pathogen detection results were compared to assess the diagnostic performance of mNGS versus traditional culture methods. Additionally, cost-effectiveness analyses of the two diagnostic strategies—as well as the impact of mNGS testing timing post-admission—were conducted in the overall cohort and across stratified subgroups. Among the 168 patients who underwent both tests, mNGS identified a greater diversity and abundance of microorganisms than culture (overall detection: 89.88% vs. 26.79%; pathogen detection: 67.86% vs. 18.45%, p < 0.001). mNGS testing yielded a net economic benefit of 1202.70 CNY per patient overall and 3831.15 CNY among pathogen-positive cases. Delaying mNGS testing tended to be associated with increased hospitalization length of stay (LOS) and costs, with the most pronounced difference observed around 6 days after admission (p < 0.001). Early mNGS testing (within 6 days of admission) provided a net benefit of 6346.00 CNY. BALF-based mNGS showed higher positivity rates and a broader pathogen detection spectrum compared to conventional culture methods in this study. Early implementation of mNGS shows strong potential to guide the treatment of pulmonary infections and reduce healthcare costs for elderly and aging patients. Diagnosing pulmonary infections in elderly patients is challenging because traditional “culture” methods often fail to find the specific germ. In this study, we analyzed bronchoalveolar lavage fluid samples from 522 patients aged 55–69, we compared a newer DNA-based testing technology called metagenomic next-generation sequencing (mNGS), a method that can simultaneously detect all genetic material in samples and identify virtually any pathogen capable of causing infection, with traditional culture methods. We then compared the results of the two methods and calculated total hospital costs—including testing, length of stay, and other related expenses. Our findings highlight three key advantages. First, mNGS detected a much wider variety of pathogens than culture methods. Second, despite the higher upfront cost of the sequencing test, using mNGS was actually cheaper overall than relying on culture, saving an average of 1202.70 CNY per patient by guiding better treatment. Third, timing is critical: performing mNGS early (within 6 days of admission) saved significantly more money compared to delayed testing. These results suggest that using mNGS early is not only clinically superior but also reduces the financial burden on patients and hospitals.

Source: Infectious Diseases and Therapy

DOI: 10.1007/s40121-026-01372-x