# Cost-effectiveness analysis of metagenomic next-generation sequencing versus traditional bacterial cultures for postoperative central nervous system infections in critical care settings: a prospective pilot study

## TL;DR

This study compares the cost-effectiveness of metagenomic sequencing versus traditional methods for diagnosing brain infections after surgery, finding that sequencing is more efficient and cost-effective despite higher initial costs.

## Contribution

The study provides the first prospective cost-effectiveness analysis of mNGS for postoperative CNSIs in critical care settings.

## Key findings

- mNGS had a shorter turnaround time (1 day vs 5 days) and lower anti-infective costs compared to traditional culture methods.
- Despite higher detection costs, mNGS was found cost-effective with an ICER of ¥36,700 per additional timely diagnosis.
- No significant differences in hospitalization duration or total costs were observed between the two methods.

## Abstract

Early and accurate pathogen identification is crucial for managing central nervous system infections (CNSIs). While Metagenomic Next-Generation Sequencing (mNGS) offers rapid and sensitive pathogen detection, its cost-effectiveness in postoperative neurosurgical patients in critical care settings remains underexplored. Our study aims to investigate the clinical health economic value of mNGS in detecting pathogens of CNSIs after neurosurgery.

In this prospective pilot study, 60 patients with CNSIs at Beijing Tiantan Hospital ICU (March 2023-January 2024) were randomized 1:1 to mNGS or conventional pathogen culture groups. A decision-tree model compared cost-effectiveness using incremental cost-effectiveness ratios (ICERs). A decision-tree model was used to compare the cost-effectiveness between mNGS and traditional pathogen culture methods using incremental cost-effectiveness ratios (ICERs).

From March 2023 to January 2024, 60 patients were included. mNGS demonstrated superior diagnostic efficiency with shorter turnaround time (1 vs 5 days; _P_<0.001) and lower anti-infective costs (¥18,000 vs ¥23,000; _P_=0.02). Despite higher detection costs (¥4,000 vs ¥2,000; _P_<0.001), the ICER of ¥36,700 per additional timely diagnosis suggested cost-effectiveness at China’s GDP-based WTP threshold. No significant differences in hospitalization duration or total costs were observed (_P_>0.05).

mNGS improves diagnostic efficiency and reduces antimicrobial expenditure for postoperative CNSIs in critical care, demonstrating favorable cost-effectiveness when considering clinical outcome gains.