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

Wendel Mombaque Dos Santos, Edoardo Aromataris, Silvia Regina Secoli, Jessica Yumi Matuoka
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引用次数: 8

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.

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耐碳青霉烯肺炎克雷伯菌感染住院患者抗菌治疗的成本效益:经济证据的系统回顾。
目的:本综述的目的是评估抗碳青霉烯耐药性肺炎克雷伯菌感染患者抗菌治疗的成本-效果。在主要的多重耐药微生物中,碳青霉烯类耐药肺炎克雷伯菌导致40%的患者在感染后30天死亡。耐碳青霉烯肺炎克雷伯菌感染的治疗需要使用高成本的抗菌剂。不适当使用抗菌素可使治疗费用增加四倍。本综述旨在评估耐碳青霉烯肺炎克雷伯菌感染患者抗菌治疗的成本-效果,以更好地为医院服务决策提供信息。纳入标准:本综述纳入了18岁或以上的碳青霉烯类耐药肺炎克雷伯菌感染患者,这些患者曾在医院和急症护理机构接受过抗菌治疗。研究比较了碳青霉烯耐药肺炎克雷伯菌感染不同抗菌治疗的成本-效果。结果测量是用临床结果单位表示的每单位效果成本;这包括每次避免死亡的成本、每次预防败血症的成本和每次住院时间的成本。考虑了具有成本效益设计的经济研究,以及建模研究。方法:采用三步搜索策略来定位以英语、西班牙语或葡萄牙语发表的研究,没有日期限制。两名独立审稿人筛选了潜在相关研究的标题、摘要和全文。方法质量由两名独立的审稿人使用JBI关键评估清单进行经济评估。使用标准化的JBI数据提取工具从纳入的研究中提取数据。数据采用叙述、表格和JBI优势排序矩阵进行综合。结果:本综述确定了8项研究,评估了碳青霉烯耐药肺炎克雷伯菌感染不同治疗方法的成本效益。本研究结果表明,耐碳青霉烯肺炎克雷伯菌感染没有金标准治疗,因此治疗通常由定植压力和耐药谱指导。此外,由于研究质量适中且数量有限,成本-效果比的值存在很高的不确定性。结论:氧氟沙星是最具成本效益的治疗方法;然而,由于研究数量少,质量低,结论有限。
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