An international cost-effectiveness study, led by researchers at the UNC School of Medicine and the Kinshasa School of Public Health, has found that an effective antibiotic used to combat maternal sepsis vastly reduces health care costs for pregnant patients.

Sepsis is one of the leading causes of maternal death—and the most expensive to treat worldwide.

Sepsis occurs when a bacterial infection spreads from one organ to the entire bloodstream. The life-threatening condition often requires hospitalization, a rapid response team, and a fast-acting antibiotic to prevent further damage to the body. And it adds up. The direct costs of sepsis care can be physically and financially catastrophic for patients and families, especially those in low- and middle-income countries.

But a new cost-effectiveness study, led by Jackie Patterson, MD, MPH and Melissa Bauserman, MD, MPH (both associate professors of pediatrics at the UNC School of Medicine), colleagues at the University of Kinshasa School of Public Health, and collaborators at RTI International, has found that an effective antibiotic used to combat maternal sepsis—azithromycin—can reduce health care costs by $32,661 per 100,000 pregnancies. Their results were published in The Lancet Global Health.

“Whenever we find a therapy that’s effective, policymakers need to understand the costs, particularly in settings where resources are limited,” said Patterson, who was first and corresponding author on the study. “Studies that look at cost-effectiveness are really important to influence policy, and, in our case, we showed that health systems can actually save money by implementing this intervention.”

Bridging the gap in maternal and children’s health

Over the past 20 years, researchers in the Democratic Republic of the Congo (DRC) and at the UNC School of Medicine have made important contributions to public health, by conducting needed research in low- and middle-income settings through the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women and Children’s Health Research.

In 2023, the UNC-Kinshasa School of Public Health research partnership participated in a large, multi-national clinical trial called the Azithromycin Prevention in Labor Use Study (A-PLUS trial) to test the effectiveness of intrapartum azithromycin, a broad-spectrum oral antibiotic, in combating maternal sepsis in pregnant women in low- and middle-income countries.

Their results, which were published in the New England Journal of Medicine, showed that a 2-gram dose of azithromycin during labor reduced the risk of maternal sepsis or death by 33% in women who delivered vaginally in the DRC, Kenya, Zambia, Bangladesh, India, Pakistan, and Guatemala.

The economic costs of sepsis

But before policy makers decide to implement effective treatments, researchers must also show that the interventions have the greatest value to maternal and child health.

Using the same data from the 29,278 women enrolled in the initial A-PLUS trial, Patterson, Bauserman, and colleagues performed an analysis to quantify the cost of azithromycin tablets and health care costs associated with maternal sepsis across all eight countries combined.

Researchers found that low- and middle-income countries would spend about $0.91 per woman planning a vaginal birth to implement intrapartum azithromycin. But when intrapartum azithromycin is used, it averts the health care costs associated with sepsis, saving the health systems $1.24 per woman planning a vaginal birth. This results in a net savings of $0.33 per pregnancy.

While $0.33 per pregnancy may not sound like much, when we take a thousand-foot view, the immensity of the savings is clear. On average, the use of intrapartum azithromycin provided a net savings of $32,661 per 100,000 pregnancies.

“This is a big deal because most health care interventions increase health care costs,” said Patterson. “We showed that using an effective intervention like azithromycin actually reduces health care costs because now these women do not need to go to a clinic or get admitted to the hospital to get treatment for sepsis.”

International impact of the study

The latest economic evidence will play a vital role as policy makers across the globe consider the use of intrapartum azithromycin as an economically efficient preventative therapy for sepsis and maternal death.

Even high-income countries, including the United States, are not immune to high rates of maternal sepsis and death. The United States has the third highest rate of maternal mortality of all high-income countries, with an estimated 3.3 maternal deaths per 10,000 live births. And in 2021, maternal sepsis accounted for $62 million in health care costs.

“Interventions like azithromycin with demonstrated effectiveness in low-resource settings may have broader applications,” said Patterson. “The research we conduct in maternal and child health internationally provides important insights that influence research, health care, and health outcomes in the United States and around the world.”