# Cost-effectiveness of maintaining an active hospital microbiology laboratory service in Timor-Leste

## TL;DR

This study shows that maintaining a hospital microbiology lab in Timor-Leste is cost-effective, reducing patient costs and deaths from bacterial infections.

## Contribution

The study provides the first cost-effectiveness analysis of active microbiology services in a lower middle-income country like Timor-Leste.

## Key findings

- Maintaining a microbiology lab reduces average patient care costs by $165,469 per 1000 patients with suspected bloodstream infection.
- The service is estimated to reduce deaths by 34 to 51 per 1000 hospitalised patients.
- The intervention is cost-effective due to reduced intensive care admissions and improved outcomes, especially for pediatric patients.

## 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 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.

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.

Our findings indicate that investment in the maintenance and expansion of local diagnostic capacity is likely to be cost-effective in resource-limited settings.

This project is funded by the 10.13039/501100000276Department of Health and Social Care (DHSC)'s Fleming Fund using UK aid.