Costs and cost-effectiveness of an infection prevention bundle to reduce neonatal sepsis and mortality in Zambia

The Sepsis Prevention in Neonates in Zambia (SPINZ) trial

Bibliographic Data

ID22437476
AuthorsLora Sabin (0000-0002-2782-542X, Boston University, corresponding author), Rebecca L West (Ipsos (United Kingdom)), Susan E Coffin (0000-0001-9566-5600, Children's Hospital of Philadelphia), Sylvia Machona (0000-0002-3306-1809, University Teaching Hospital), Carter Cowden (0000-0001-6031-5803, Children's Hospital of Philadelphia), Lawrence Mwananyanda (0000-0002-3034-749X, Boston University), Chileshe L Musyani (0000-0002-0262-4779, Lusaka Apex Medical University), John Tembo (0000-0002-6660-9877, Centre for Infectious Disease Research in Zambia), Matthew Bates (0000-0002-5250-445X, University of Lincoln), Davidson H Hamer (0000-0002-4700-1495, Boston University)
EditorsHannah Tappis (0000-0002-4289-5418)
Year2026
Volume6
Issue7
Pagese0006016
Publication date2026-07-15
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0006016
PMID42455853
OpenAlexW7168396255
LanguageEN
References cited16

The Sepsis Prevention in Neonates in Zambia (SPINZ) trial was a prospective observational cohort study conducted in the neonatal intensive care unit of the University Teaching Hospital in Lusaka, Zambia. Introduction of an infection prevention and control (IPC) bundle reduced hospital-associated mortality, total mortality, suspected sepsis, and confirmed bloodstream infections. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness in this low-resource setting. We conducted a retrospective cost analysis, using SPINZ study-related records, and expressed costs in real 2016 US dollars. We also estimated intervention cost-effectiveness using both outcomes from SPINZ (avoided deaths, confirmed bloodstream infections, and suspected episodes of infection) and estimated disability-adjusted life years (DALYs) averted by the intervention. To provide data for policymakers, a future cost projection was undertaken to estimate costs of the program implemented nationally over a 10-year period in real 2025 US dollars. A total of 2,035 neonates were enrolled from September 2015 to March 2017. Total costs during implementation (introduction of the IPC bundle) (April-May 2016) and the subsequent intervention period were $17,641 and $5,265, respectively, of which most expenses were incurred during the preparation period due to travel and training. During the intervention period, the program’s running cost was approximately $478 per month. The estimated cost per death, confirmed infection, and suspected episode averted was $208, $204, and $32, respectively; the estimated cost per DALY averted was $7. The future model was estimated to cost an average of $107,561 annually to implement nationally. The analysis indicated that the IPC bundle to prevent sepsis-related neonatal mortality was highly cost-effective. Cost reductions from task-shifting, reduced preparation (start-up) costs, and longer intervention periods would further decrease cost per death averted. IPC bundle implementation can thus be recommended for resource-constrained settings where sepsis and other nosocomial infections are associated with high neonatal mortality.

Cohort · Cohort study · Cost effectiveness · Infection control · Intervention (counseling) · Neonatal intensive care unit · Neonatal sepsis · Observational study · Sepsis · Total cost · Neonatal and Maternal Infections · Neonatal Respiratory Health Research · Sepsis Diagnosis and Treatment