OBJECTIVES: To explore the cost-effectiveness of a rapid ID/AST solutions in the management of patients with bloodstream infection compared to standard of care from a French payer perspective.

METHODS: A decision-analytic model based on the published literature and clinical expert validation was build comparing both health outcomes and direct healthcare costs of a hypothetical BSI in-hospital patient cohort diagnosed with and without a rapid ID/AST solution (i.e., results within 6h). A short-term time horizon until discharge or death was applied and the incremental cost-effectiveness ratio was calculated to estimate the cost per death averted. To deal with uncertainty and to test robustness of the model, one-way and probabilistic sensitivity analyses were conducted.

RESULTS: The use of a rapid ID/AST solution was cost-saving and lifesaving when compared to standard of care in BSI management, by starting earlier with appropriate treatment. In terms of clinical outcomes, rapid ID/AST reduced mortality by 3.8%, sepsis cases by 8.9% and septic shock cases by 4.6% (base case analysis). In terms of economic outcomes, a rapid ID/AST solution generated cost-savings of 794€ per BSI patient and a reduction of 1.5 general ward bed-days/patient while reducing ICU-stay with 1.1 day/patient. The sensitivity analyses demonstrated robustness of the base-case results.

CONCLUSIONS: Our model indicates that the introduction of a rapid ID/AST solution to manage in-hospital patients with BSI is a dominant/cost-saving strategy compared to SoC by reducing time to appropriate treatment. As a result, when clinicians will act upon these results in a real clinical setting, overall inappropriate empiric antibiotic prescriptions will be reduced which is then expected to decrease deterioration into sepsis and may have a positive impact on the burden of antimicrobial resistance on the long-term. Finally, the results of this explorative model, demonstrating both high medical and economic value, are in line with the WHO AMR priority recommendations.