Empirical antibiotics versus definitive antibiotics for Sepsis patients in Indonesia: A cost-effectiveness analysis

Abstract

Sepsis is a life-threatening issue worldwide. Antibiotics, including antibiotic treatment (ET) and culture-based treatment (CBT), are crucial therapies for sepsis treatment. However, there is insufficient evidence to compare their cost-effectiveness in Indonesia. This study evaluates the cost-effectiveness of these two antibiotic approaches in Indonesian patients. A decision-tree model was developed from a healthcare payer perspective, with a 1-year time horizon. The Incremental Cost-Effectiveness Ratio (ICER), i.e., the incremental cost per death averted, was estimated to compare the cost-effectiveness between two interventions. The willingness-to-pay threshold (WTP) was one to three times the gross domestic product (GDP) per capita (1 GDP per capital: IDR 72,333,083 [US$ 4,788]). One-way and probability sensitivity analyses were performed to assess the robustness of our findings. In base-case analysis, CBT prevented 347 patient deaths compared to ET, incurring an additional cost of IDR 8,873,397,000 (US$ 588,000) with an ICER of IDR 25,571,749 (US$ 1,693) per death averted. The probability of CBT being cost-effective was 72%–80% using the one- and three-times GDP per capita threshold, respectively. Utilizing the CBT for sepsis treatment is cost-effective compared with the ET. These findings can support clinicians and policymakers in facilitating the use of CBT in sepsis treatment in Indonesia.