Costs-effectiveness and cost components of pharmaceutical and non-pharmaceutical interventions affecting antibiotic resistance outcomes in hospital patients: a systematic literature review

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dc.contributor.authorAllel, Kasim
dc.contributor.authorHernandez-Leal, Maria Jose
dc.contributor.authorNaylor, Nichola R.
dc.contributor.authorUndurraga, Eduardo A.
dc.contributor.authorAbou Jaoude, Gerard Joseph
dc.contributor.authorBhandari, Priyanka
dc.contributor.authorFlanagan, Ellen
dc.contributor.authorHaghparast-Bidgoli, Hassan
dc.contributor.authorPouwels, Koen B.
dc.contributor.authorYakob, Laith
dc.date.accessioned2025-01-20T17:07:41Z
dc.date.available2025-01-20T17:07:41Z
dc.date.issued2024
dc.description.abstractIntroduction Limited information on costs and the cost-effectiveness of hospital interventions to reduce antibiotic resistance (ABR) hinder efficient resource allocation.Methods We conducted a systematic literature review for studies evaluating the costs and cost-effectiveness of pharmaceutical and non-pharmaceutical interventions aimed at reducing, monitoring and controlling ABR in patients. Articles published until 12 December 2023 were explored using EconLit, EMBASE and PubMed. We focused on critical or high-priority bacteria, as defined by the WHO, and intervention costs and incremental cost-effectiveness ratio (ICER). Following Preferred Reporting Items for Systematic review and Meta-Analysis guidelines, we extracted unit costs, ICERs and essential study information including country, intervention, bacteria-drug combination, discount rates, type of model and outcomes. Costs were reported in 2022 US dollars ($), adopting the healthcare system perspective. Country willingness-to-pay (WTP) thresholds from Woods et al 2016 guided cost-effectiveness assessments. We assessed the studies reporting checklist using Drummond's method.Results Among 20 958 articles, 59 (32 pharmaceutical and 27 non-pharmaceutical interventions) met the inclusion criteria. Non-pharmaceutical interventions, such as hygiene measures, had unit costs as low as $1 per patient, contrasting with generally higher pharmaceutical intervention costs. Several studies found that linezolid-based treatments for methicillin-resistant Staphylococcus aureus were cost-effective compared with vancomycin (ICER up to $21 488 per treatment success, all 16 studies' ICERs<WTP). Infection control measures such as hand hygiene and gown usage (ICER=$1160/QALY or $4949 per ABR case averted, all ICERs<WTP) and PCR or chromogenic agar screening for ABR detection were highly cost-effective (eg, ICER=$1206 and $1115 per life-year saved in Europe and the USA). Comparisons were hindered by within-study differences.Conclusion Robust information on ABR interventions is critical for efficient resource allocation. We highlight cost-effective strategies for mitigating ABR in hospitals, emphasising substantial knowledge gaps, especially in low-income and middle-income countries. Our study serves as a resource for guiding future cost-effectiveness study design and analyses. PROSPERO registration number CRD42020341827 and CRD42022340064Conclusion Robust information on ABR interventions is critical for efficient resource allocation. We highlight cost-effective strategies for mitigating ABR in hospitals, emphasising substantial knowledge gaps, especially in low-income and middle-income countries. Our study serves as a resource for guiding future cost-effectiveness study design and analyses. PROSPERO registration number CRD42020341827 and CRD42022340064
dc.fuente.origenWOS
dc.identifier.doi10.1136/bmjgh-2023-013205
dc.identifier.issn2059-7908
dc.identifier.urihttps://doi.org/10.1136/bmjgh-2023-013205
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/90882
dc.identifier.wosidWOS:001179402400005
dc.issue.numero2
dc.language.isoen
dc.revistaBmj global health
dc.rightsacceso restringido
dc.subjectPublic Health
dc.subjectControl strategies
dc.subjectPrevention strategies
dc.subjectSystematic review
dc.subjectInfections, diseases, disorders, injuries
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleCosts-effectiveness and cost components of pharmaceutical and non-pharmaceutical interventions affecting antibiotic resistance outcomes in hospital patients: a systematic literature review
dc.typeartículo
dc.volumen9
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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