Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-LesteResearch in context
Summary: Background: 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 mid...
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Elsevier
2025-05-01
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| Series: | The Lancet Regional Health - Southeast Asia |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772368225000538 |
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| author | Cherry Lim Myo Maung Maung Swe Angela Devine Tessa Oakley Karen Champlin Pyae Sone OO Nevio Sarmento Ismael Da Costa Barreto Rodney C. Givney Jennifer Yan Joshua R. Francis Ben S. Cooper |
| author_facet | Cherry Lim Myo Maung Maung Swe Angela Devine Tessa Oakley Karen Champlin Pyae Sone OO Nevio Sarmento Ismael Da Costa Barreto Rodney C. Givney Jennifer Yan Joshua R. Francis Ben S. Cooper |
| author_sort | Cherry Lim |
| collection | DOAJ |
| description | Summary: Background: 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. Methods: We constructed a decision tree model and performed a cost-effectiveness analysis to determine whether maintaining an active microbiology laboratory service would be cost-effective in Timor-Leste, a lower middle-income country. The model was informed by local microbiology data, local patient treatment costs, results of an expert elicitation exercise and data from literature reviews. Findings: Compared with no active microbiology laboratory, average patient care costs would be reduced by $165,469 (IQR: $134,834–200,902) for every 1000 hospitalised patients with suspected bloodstream infection. Maintaining an active microbiology laboratory was estimated to reduce deaths by between 34 and 51 per 1000 hospitalised patients. Similar results were found under various one-way sensitivity analyses. Accordingly, our 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) compared to no microbiological testing, especially for the hospitalised paediatric patients with suspected primary bacteraemia. Interpretation: Our findings indicate that investment in the maintenance and expansion of local diagnostic capacity is likely to be cost-effective in resource-limited settings. Funding: This project is funded by the Department of Health and Social Care (DHSC)'s Fleming Fund using UK aid. |
| format | Article |
| id | doaj-art-5f06ffd16d83454f9b93d5906b0cbfd0 |
| institution | DOAJ |
| issn | 2772-3682 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health - Southeast Asia |
| spelling | doaj-art-5f06ffd16d83454f9b93d5906b0cbfd02025-08-20T02:57:41ZengElsevierThe Lancet Regional Health - Southeast Asia2772-36822025-05-013610058210.1016/j.lansea.2025.100582Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-LesteResearch in contextCherry Lim0Myo Maung Maung Swe1Angela Devine2Tessa Oakley3Karen Champlin4Pyae Sone OO5Nevio Sarmento6Ismael Da Costa Barreto7Rodney C. Givney8Jennifer Yan9Joshua R. Francis10Ben S. Cooper11Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Corresponding author. Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United KingdomGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, AustraliaGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-LesteGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-LesteCentre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United KingdomGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-LesteNational Institute of Public Health, Timor-LesteGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-LesteGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-LesteGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-LesteCentre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, ThailandSummary: Background: 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. Methods: We constructed a decision tree model and performed a cost-effectiveness analysis to determine whether maintaining an active microbiology laboratory service would be cost-effective in Timor-Leste, a lower middle-income country. The model was informed by local microbiology data, local patient treatment costs, results of an expert elicitation exercise and data from literature reviews. Findings: Compared with no active microbiology laboratory, average patient care costs would be reduced by $165,469 (IQR: $134,834–200,902) for every 1000 hospitalised patients with suspected bloodstream infection. Maintaining an active microbiology laboratory was estimated to reduce deaths by between 34 and 51 per 1000 hospitalised patients. Similar results were found under various one-way sensitivity analyses. Accordingly, our 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) compared to no microbiological testing, especially for the hospitalised paediatric patients with suspected primary bacteraemia. Interpretation: Our findings indicate that investment in the maintenance and expansion of local diagnostic capacity is likely to be cost-effective in resource-limited settings. Funding: This project is funded by the Department of Health and Social Care (DHSC)'s Fleming Fund using UK aid.http://www.sciencedirect.com/science/article/pii/S2772368225000538Cost-effectiveMicrobiology laboratory servicesAntibiotic use |
| spellingShingle | Cherry Lim Myo Maung Maung Swe Angela Devine Tessa Oakley Karen Champlin Pyae Sone OO Nevio Sarmento Ismael Da Costa Barreto Rodney C. Givney Jennifer Yan Joshua R. Francis Ben S. Cooper Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-LesteResearch in context The Lancet Regional Health - Southeast Asia Cost-effective Microbiology laboratory services Antibiotic use |
| title | Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-LesteResearch in context |
| title_full | Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-LesteResearch in context |
| title_fullStr | Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-LesteResearch in context |
| title_full_unstemmed | Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-LesteResearch in context |
| title_short | Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-LesteResearch in context |
| title_sort | cost effectiveness of maintaining an active hospital microbiology laboratory service in timor lesteresearch in context |
| topic | Cost-effective Microbiology laboratory services Antibiotic use |
| url | http://www.sciencedirect.com/science/article/pii/S2772368225000538 |
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