Cost-Effectiveness of Infection Prevention and Control Measures for Carbapenem-Resistant Gram-Ne

28 Apr 20264 min read0 viewsJournal Feed

GIST

Introduction Multidrug-resistant organisms, including carbapenem-resistant Gram-negative bacilli (CRGNB), have a heavy health and economic burden in healthcare settings. Assessing the costs and clinical impact of infection prevention and control (IPC) measures targeted at CRGNB is essential to determine their cost-effectiveness and guide the allocation of limited resources.

Systematic reviews of clinically effective IPC measures for carbapenem-resistant bacteria exist; however, similar reviews of economic analyses of IPC measures are lacking. Hence, the goal of this paper is to produce a protocol for a systematic review of economic evaluations of IPC measures targeting CRGNB in healthcare settings.

Methods and analysis We will query CINAHL, Medline and Embase (via Ebsco), Web of Science, Cochrane, and the grey literature for studies published between 1 January 2009 and 1 January 2026. We will include quantitative studies that describe any of the IPC strategies recommended by the WHO including hand hygiene, surveillance, contact precautions, patient isolation (single room isolation or cohorting), and environmental cleaning and that apply at least one type of economic analysis, such as cost-effectiveness, cost-benefit, cost-minimisation, cost - utility or cost - consequence.

Clinical Editorial

Strategic aim and scope of inquiry

The document outlines a protocol to evaluate the economic value of infection prevention and control measures aimed at carbapenem-resistant Gram-negative bacilli (CRGNB) in healthcare settings.
It notes a gap: prior work assesses clinical effectiveness of IPC strategies, but economic analyses have not been comprehensively reviewed.

Study design and methodological framework

This is a protocol for a systematic review of economic evaluations, not results from a completed analysis.
The planned search covers multiple bibliographic databases (CINAHL, Medline, Embase via Ebsco, Web of Science, Cochrane) and grey literature for studies published from January 1, 2009 to January 1, 2026.
Eligible designs are quantitative studies describing IPC strategies endorsed by the WHO, including hand hygiene, surveillance, contact precautions, patient isolation (single-room isolation or cohorting), and environmental cleaning, accompanied by at least one economic analysis type (cost-effectiveness, cost-benefit, cost-minimisation, cost-utility, or cost-consequence).

Population, interventions, and outcomes under consideration

Interventions of interest align with WHO-recommended IPC measures specific to CRGNB within healthcare environments.
Outcomes of interest include net cost savings, incremental cost-effectiveness ratios, and incremental cost metrics per QALY or DALY.

Data handling and quality appraisal

Study screening will involve three independent reviewers per article.
Data extraction will be conducted independently by one reviewer and an AI tool (Elicit), with subsequent verification by another reviewer, culminating in a single synthesized document.
Methodological quality will be appraised using three instruments: SI- Scottish Intercollegiate Guidelines Network checklist for economic evaluations, Drummond’s criteria for economic evaluations, and the Cochrane Handbook for Systematic Reviews of Interventions.
Inter-rater agreement will be quantified as a percentage.

Synthesis approach and economic considerations

The protocol proposes a dominance framework from the Joanna Briggs Institute to categorize interventions as favoured, rejected, or indeterminate.
Extracted economic data will be adjusted to 2026 Canadian dollars using specified discount rates (3%, 5%, and 8%), with subsequent sensitivity analyses planned.
The synthesis intends to narratively integrate findings and present adjusted economic values, acknowledging uncertainty where applicable.

Contextual and reporting notes

The ethics statement asserts no ethical approval is required for this protocol.
Dissemination is planned within the confines of a protocol publication, with the formal trial registry identifier noted as reviewregistry1948.

Limitations and transparency considerations

As a protocol, direct results, effect sizes, or concrete estimates are not reported.
The plan explicitly acknowledges potential uncertainties in data extraction, quality appraisal, and economic adjustment processes.
It is stated that no ethical concerns are anticipated given the protocol nature of the work.