title: Performance Requirements to Achieve Cost-Effectiveness of Point-of-Care Tests for Sepsis Among Patients with Febrile Illness in Low-Resource Settings.
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.affiliation: Department of Preventive and Social Medicine, Centre for Health Systems, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Centre for International Health, University of Otago, Dunedin, New Zealand; Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Erin C
authors.initials: EC
authors.lastname: Penno
authors.affiliation: Department of Preventive and Social Medicine, Centre for Health Systems, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Centre for International Health, University of Otago, Dunedin, New Zealand; Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.affiliation: Department of Preventive and Social Medicine, Centre for Health Systems, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Centre for International Health, University of Otago, Dunedin, New Zealand; Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC sbaird@gwu.edu.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Baird
mesh_terms: D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D005334:Fever / Q000175:diagnosis* / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D018803:Models, Economic; D019095:Point-of-Care Systems / Q000191:economics*; D015995:Prevalence; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000401:mortality
chemical_list: D000890:Anti-Infective Agents