Cost-Effectiveness of a Target Point-of-Care Triage Test for Neonatal Sepsis in Low- and Middle-Income Countries

Maxim Fedorov, Akhil Bansal, Georgia Bradley, Daniel Chong, Yasir Nisar, Edwine Barasa, Yah Juang, Teerawat Wiwatpanit, Siriyada Kitbamrung, Nga Lui, Xue Li and Yi Wang
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Maxim Fedorov: Saw Swee Hock School of Public Health, National University of Singapore
Akhil Bansal: Center for Global Development
Georgia Bradley: Dartmouth College
Daniel Chong: Saw Swee Hock School of Public Health, National University of Singapore
Yasir Nisar: Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing, World Health Organization
Edwine Barasa: Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme
Yah Juang: Saw Swee Hock School of Public Health, National University of Singapore
Teerawat Wiwatpanit: Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand
Siriyada Kitbamrung: Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand
Nga Lui: Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong
Xue Li: Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong
Yi Wang: Saw Swee Hock School of Public Health, National University of Singapore

No 744, Working Papers from Center for Global Development

Abstract: Neonatal sepsis is a leading cause of mortality in low- and middle-income countries (LMICs). The current diagnostic standard, blood culture, has long turnaround times and high infrastructure requirements, limiting its utility. Consequently, clinicians rely on non-specific clinical signs for initial management. To address this unmet need, the WHO published a 2025 Target Product Profile (TPP) for rapid point-of-care tests (POCTs). We developed a global expert-validated model to estimate the cost-effectiveness of a TPP-compliant POCT in LMICs. A decision tree compared a TPP-compliant POCT integrated into standard of care (SOC) against SOC alone from a healthcare system perspective over a lifetime horizon. The model evaluated infants (0–59 days) with possible serious bacterial infection across facility-of-birth and community-presenting cohorts. Outcomes included incremental cost per disability-adjusted life-year (DALY) averted. Probabilistic and threshold sensitivity analyses assessed parameter uncertainty. At a US$ 5·00 unit price, the POCT reduced costs by US$ 37 342 and averted 206 DALYs per 1 000 facility-of-birth patients compared to SOC. In community-presenting patients, it reduced costs by US$ 5 715 and averted 127 DALYs per 1 000. The POCT was dominant in 93·2% (facility) and 84·8% (community) of probabilistic iterations. Results remained robust across wide-ranging epidemiological and cost inputs. These findings provide an evidence base supporting prioritised investment in developing a TPP-compliant POCT to improve neonatal sepsis management in LMICs.

Pages: 23 pages
Date: 2026-04-28
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