Cost-effectiveness of antimicrobial treatment for inpatients with carbapenem-resistant Klebsiella pneumoniae infection: a systematic review of economic evidence

Abstract

Objectives: The objective of this review was to evaluate the cost-effectiveness of antimicrobial therapy for patients with carbapenem-resistant Klebsiella pneumoniae infection. Introduction: Among the main multi-resistant microorganisms, carbapenem-resistant K. pneumoniae is responsible for the mortality of 40% of patients following 30 days of infection. Treatment for carbapenem-resistant K. pneumoniae infection entails the use of high-cost antimicrobials. Inappropriate use of antimicrobials can increase the cost of treatment fourfold. This review aimed to evaluate the cost-effectiveness of antimicrobial therapy treatment for patients with carbapenem-resistant K. pneumoniae infection to better inform decision making in hospital services. Inclusion criteria: The review included studies on participants 18 years or over with carbapenem-resistant K. pneumoniae infection who had undergone antimicrobial therapy in hospital and acute care services. Studies that compared the cost-effectiveness of different antimicrobial therapy for carbapenem-resistant K. pneumoniae infection were included. Outcome measures were cost per unit of effect expressed in clinical outcome units; this included cost per avoided death, cost per prevention of sepsis and cost per duration of stay. Economic studies with a cost-effectiveness design were considered, as well as modeling studies. Methods: A three-step search strategy was utilized to locate studies published in English, Spanish or Portuguese, with no date restrictions. Two independent reviewers screened titles and abstracts and the full texts of potentially relevant studies for eligibility. Methodological quality was assessed by two independent reviewers using the JBI critical appraisal checklist for economic evaluations. Data were extracted from included studies using the standardized JBI data extraction tool. Data were synthesized using narrative, tables and the JBI Dominance Ranking Matrix. Results: This review identified eight studies that evaluated the cost-effectiveness of different treatments for carbapenem-resistant K. pneumoniae infection. The results of this study demonstrated that there was no gold standard treatment for carbapenem-resistant K. pneumoniae infection, hence treatment was generally directed by colonization pressure and resistance profiles. Furthermore, due to the moderate quality and limited number of studies, there was high uncertainty of the values of the cost-effectiveness ratio. Conclusions: Ofloxacin appears to be the most cost-effective treatment; however, conclusions are limited due to the small number and low quality of studies.

The cost-effectiveness of temporary single-patient rooms to reduce risks of healthcare-associated infection

“…An essay on the role of economic evaluation regarding HAI is available (24) and covers the topics of why the discipline of economics is useful for infection control professionals, how measures of economic outcomes should be achieved, how decision-makers should use the results of economic evaluation studies, and importantly, an argument is made that good economics can improve the amount of health gained from an infection prevention service working under conditions of scarce resources. A range of narrative and systematic reviews have been done on the economics of competing infection prevention interventions (56)(57)(58)(59)(60)(61)(62)(63)(64)(65) These findings reported here provide some evidence that the adoption of single portable isolation rooms by the NHS will be a cost-effective decision. This conclusion is robust to uncertainty arising from model parameters and to plausible scenarios.…”

Effectiveness of auriculotherapy for anxiety, stress or burnout in health professionals: a network meta-analysis

“…The instruments used were those recommended by the JBI 17 for randomized clinical trials (individual participants in parallel groups), quasi-experimental studies (non-randomized experimental studies) and multiple cases. The methodological quality level was determined as follows: reasonable quality = less than 40% of the items presented; moderate quality = between 41 and 80% of the items presented; good quality = more than 80% of the items presented 21 . All articles were considered for the synthesis of the evidence, without determining the cutoff point for inclusion, as recommended by the JBI 17 , and the result of the critical evaluation was presented for each study.…”

Efectividad de la auriculoterapia para la ansiedad, el estrés o el burnout en profesionales de la salud: metaanálisis en red

“…Los instrumentos utilizados fueron los recomendados por el JBI (17) para ensayos clínicos aleatorizados (participantes individuales en grupos paralelos), estudios cuasiexperimentales (estudios experimentales no aleatorizados) y casos múltiples. El nivel de calidad metodológica se determinó de la siguiente manera: calidad razonable = menos del 40% de los ítems presentados; calidad moderada = entre 41 y 80% de los ítems presentados; buena calidad = más del 80% de los ítems presentados (21) . Todos los artículos fueron considerados para la síntesis de evidencia, sin determinar punto de corte para inclusión, como lo recomienda el JBI (17) , y se presentó el resultado de la evaluación crítica para cada estudio.…”