Systematic review of methodological approaches in economic evaluations of maternal and neonatal sepsis interventions in low- and middle-income countries.

BACKGROUND

Maternal and neonatal sepsis remains a leading cause of preventable morbidity and mortality in low- and middle-income countries (LMICs). While economic evaluations can support resource allocation and policy decisions, it is unclear how well existing studies capture both the costs (inputs) and outcomes associated with sepsis care. This systematic review aims to examine the methodological approaches used in economic evaluations of maternal and neonatal sepsis in LMICs, to identify common practices, strengths, and limitations, rather than to summarise specific economic outcomes.

METHODS

We conducted a systematic review of economic evaluations related to maternal and neonatal sepsis in LMICs. A total of 23 peer-reviewed studies were included, representing data from over 40 countries. We assessed study design, costing methods, outcome measures, time horizons, and analytic perspectives. Key limitations and strengths were identified through narrative synthesis, and statistical tests were not applicable given the heterogeneity of the data.

RESULTS

Only five of the 23 studies focused exclusively on sepsis, reflecting a tendency to address it within broader maternal and neonatal care interventions. We observed wide methodological variation, including inconsistent costing approaches, outcome metrics (e.g., DALYs, QALYs, lives saved), and time horizons. Many studies lacked transparency or comparability, limiting their utility for decision-makers. However, some examples demonstrated robust design and relevance to routine care contexts. Drawing on these, we identify core components of methodological best practice and present a flexible, yet rigorous, framework to support future evaluations focused more explicitly on sepsis.

CONCLUSIONS

The current evidence base for economic evaluations of maternal and neonatal sepsis in LMICs is sparse and methodologically inconsistent. By clarifying key gaps and highlighting good practice, this review provides pragmatic guidance for future studies. Strengthening economic evaluations—particularly within routine maternal and neonatal care bundles—can support better-informed decisions by planners, funders, and policymakers, ultimately improving outcomes for mothers and newborns in resource-constrained settings.