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

IntroductionLimited information on costs and the cost-effectiveness of hospital interventions to reduce antibiotic resistance (ABR) hinder efficient resource allocation.MethodsWe conducted a systematic literature review for studies evaluating the costs and cost-effectiveness of pharmaceutical and no...

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Published in:BMJ global health 2024-02, Vol.9 (2), p.e013205
Main Authors: Allel, Kasim, Hernández-Leal, María José, Naylor, Nichola R, Undurraga, Eduardo A., Abou Jaoude, Gerard Joseph, Bhandari, Priyanka, Flanagan, Ellen, Haghparast-Bidgoli, Hassan, Pouwels, Koen B, Yakob, Laith
Format: Article
Language:English
Subjects:
Antibiotic resistance
Antibiotics
Antimicrobial agents
Control strategies
Cost analysis
Cost control
Drug resistance
GDP
Gross Domestic Product
Health care expenditures
Hospitals
Infections, diseases, disorders, injuries
Intervention
Literature reviews
Original Research
Pathogens
Patients
Penicillin
Personal hygiene
Pharmaceuticals
Prevention strategies
Public Health
Resource allocation
Staphylococcus infections
Systematic review
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Summary:IntroductionLimited information on costs and the cost-effectiveness of hospital interventions to reduce antibiotic resistance (ABR) hinder efficient resource allocation.MethodsWe 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.ResultsAmong 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
ISSN:2059-7908
2059-7908
DOI:10.1136/bmjgh-2023-013205