The Clinical and Economic Value of Incorporating Monocyte Distribution Width Testing in the Detection of Occult Sepsis.

Background: Sepsis is a leading cause of morbidity, mortality, and increased healthcare costs. Early recognition is critical, yet occult sepsis often evades standard screening, delaying care and worsening outcomes. Monocyte distribution width (MDW), a novel blood biomarker automatically reported with a routine complete blood cell count (CBC), has emerged as a promising tool for early detection of occult sepsis in adult patients in the emergency department (ED). Objectives: To evaluate the clinical and economic impact of incorporating MDW into standard ED sepsis screening vs standard of care (SoC). Methods: This study utilized a cost-consequence model to evaluate the clinical and economic impact of incorporating MDW into standard ED sepsis screening compared with standard screening (SoC) alone. Adults presenting to the ED and meeting sepsis criteria within 24 hours of CBC collection were stratified by sepsis suspicion level (no, low, high) and MDW values (normal, elevated). Outcomes, including time-to-antibiotics, hospital and intensive care unit (ICU) length of stay (LOS), ICU admission, mortality, and readmissions, were estimated using trial data and regression models from published literature. Costs were assessed from a US provider perspective in 2024 US dollars. Results: In the base case, SoC + MDW testing was associated with lower costs per patient than SoC ( Conclusions: MDW was found to be a low-cost tool that can strengthen sepsis screening by flagging cases earlier, especially in occult sepsis. Because it is reported with a routine CBC, MDW can be readily implemented and may improve outcomes while reducing costs.