Fast identification and antimicrobial susceptibility testing (fast ID/AST) for sepsis has the potential to prevent approximately 84,400 sepsis cases and 36,200 sepsis-related deaths in the US each year, according to a new report published by the Office of Health Economics.

Sepsis remains a substantial disease burden worldwide, and patients can deteriorate rapidly, but the current diagnostics take days to deliver results, according to the report’s authors. Fast diagnostics have shown the ability to shorten the time needed to provide appropriate therapy, but they remain underused, mainly because of structural and workflow barriers, according to the report.

“When it comes to sepsis, the window for effective intervention is narrow, and every hour of delay increases the risk of death,” said Tom Heymann, president and CEO of the Sepsis Alliance, an advocacy organization working to raise sepsis awareness and improve patient care.

“Standard diagnostic methods could take 2-3 days to return results, which forces healthcare professionals to make high-stakes treatment decisions without the information they need, often relying on broad-spectrum antibiotics that may not target the specific pathogen,” Heymann said.

The researchers analyzed published studies, administrative data, and clinical expert reviews regarding the potential impact of fast ID/AST for health systems in the US as well as Canada, France, Germany, Italy, Japan, and the UK.

They created a decision tree model showing the effects of fast ID/AST on clinical progression, mortality, post-sepsis consequences, and quality-adjusted life expectancy, as well as on health system costs, over a period from initial hospitalization through a 12-month follow-up.

In the US, the implementation of fast ID/AST was associated with approximately $3400 in cost savings per patient, for an annual healthcare system savings of approximately $3 billion at the population level, according to the report. This savings stemmed from shorter hospital stays and fewer patients admitted to the ICU, as well as reduced need for management of severe complications, according to the report. The cost savings reflect reductions in acute phase costs and the costs associated with long-term complications.

Implications and Implementation

“Deploying fast ID/AST for bloodstream infection patients at high risk of sepsis can prevent progression, reduce deaths, and spare patients the long-term complications that sepsis survivors carry for years,” Heymann told Medscape Medical News.

However, barriers to implementation persist, Heymann said. These include the existing health technology assessment frameworks, which focus on a test’s analytic accuracy, not on the downstream value, and the current inclusion of diagnostic costs in fixed payments for a given condition, which can make fast testing look like an additional expense on paper, although it saves the system money overall, he noted.

“Lab budgets absorb the cost of diagnostics, while the savings flow to ICU, ward, and post-discharge care; this financial disconnect is one of the most significant structural barriers to adoption of fast testing,” Heymann added. Finally, lab hours, communication protocols, and alignment between diagnostic turnaround and antibiotic decisions can affect the value of fast testing even when it is available, he said.

Looking ahead, real-world implementation studies would be a valuable next step to build on the findings of the Office of Health Implementation report, said Heymann. “While this analysis focuses on direct healthcare system costs, future studies that incorporate productivity losses, caregiver burden, and long-term disability costs would build an even stronger case for the full societal value of fast diagnostics,” he said.

“In terms of advocacy, the most important step is connecting diagnostic costs to system-wide savings; labs bear the cost of diagnostics while the benefits accrue elsewhere,” Heymann said. “Healthcare professionals who can make that case internally, and push for protocols that ensure fast results trigger immediate treatment decisions, are best positioned to drive change,” he said.

The report was commissioned and funded by bioMérieux. Heymann had no financial conflicts to disclose.