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Abstract Introduction Data on bloodstream infections (BSI) indicate a growth in incidence over time. This analysis utilised national data from England and the best available United States (US) evidence to predict BSI incidence over the years 2025 to 2029. The analysis utilised evidence on the cost-effectiveness of molecular rapid diagnostic tests (mRDT) to estimate the cost and mortality associated with BSI, and the potential for increased use of mRDT to save lives. Methods Data on BSI incidence by age group and sex for England in 2017 and the US (Minnesota) for 2003 to 2005 were combined with demographic projections over the years 2025 to 2029 to estimate the number of BSIs. Published costs and mortality associated with BSI, according to the method of identification of the pathogen, were used to estimate the lives saved and the cost impact of widespread use of mRDT in England and the US. Results BSI cases in England and the US are predicted to total 1.02 million and 6.24 million over the years 2025 to 2029, associated costs are £14.6 million and $221 million, respectively. Expanding the use of mRDT would save 2,219 and 7,554 lives in England and the US, respectively, over a 5-year period and would reduce healthcare expenditure in both countries. Conclusion There is a compelling argument to increase the uptake of mRDT to improve patient outcomes. This analysis demonstrates that expanded mRDT adoption can significantly reduce BSI burden, saving over 9,700 lives and decreasing healthcare expenditure in both countries. Key messages There are an estimated 186,000 BSIs in England annually, with an associated mortality of around 21,000 deaths. In the US, there are over 1.12 million BSIs per year, with over 125,000 deaths. Over a five-year period in England, introduction of the Cobas® Eplex blood culture identification (BCID) panels would save 2,219 lives and would also reduce healthcare costs by over £50 million, while in the US, introduction of the Cobas Eplex BCID panels in hospitals not using mRDT would lead to over 7,500 lives saved and a cumulative saving of over $500 million over the period 2025 to 2029. Use of mRDT can save lives and reduce costs through more rapid identification of BSIs and faster optimisation of therapy.