Is an active hospital microbiology laboratory cost-effective in a resource-limited setting? - a case study from Timor-Leste.

Abstract

Maintaining an active hospital microbiology laboratory allows definitive antibiotic treatment for bacterial infections to be given in a timely manner. This would be expected to improve patient outcomes and shorten length of hospital stay. However, many hospitals in low- and middle-income countries lack access to microbiology services, and the cost-effectiveness of an active microbiology service is unknown. We constructed a decision tree and performed a cost-effectiveness model analysis to determine whether maintaining an active microbiology laboratory service would be cost-effective in Timor-Leste, a lower middle-income country. The analysis was informed by local microbiology data, local patient treatment costs, results of an expert elicitation exercise and data from literature reviews. The results indicate that there is a high probability that maintaining an active microbiology laboratory is a cost-effective intervention that would both improve patient outcomes and reduce net costs (due to reduced intensive care admissions and potential costs of resistant infections) compared to no microbiological testing, especially for the hospitalised paediatric patients with suspected primary bacteraemia. This remained true under various one-way sensitivity analyses, including when accuracy of microbiological testing is low, prevalence of bacterial infection among patients with suspected bloodstream infection was high, and prevalence of antibiotic resistance was high.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was funded by the Fleming Fund Country Grant to Timor-Leste. The Fleming Fund is a UK Aid fund administered by the UK Government's Department of Health and Social Care, which supports antimicrobial resistance surveillance activities in at least 25 countries around the world.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present work are contained in the manuscript

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