Objectives:
The objective of this review was to evaluate the cost-effectiveness of antimicrobial therapy for patients infected with Klebsiella pneumoniae carbapenemase .
Introduction:
Among the main multi-resistant microorganisms, Klebsiella pneumoniae carbapenemase is responsible for the mortality of 40% of patients following 30 days of infection. Antimicrobial therapy for Klebsiella pneumoniae carbapenemase entails the use of high-cost antimicrobials. Inappropriate use of antimicrobials can increase the cost of treatment by up to four times. This review aimed to evaluate the cost-effectiveness of antimicrobial therapy treatment for patients infected with Klebsiella pneumoniae carbapenemase to better inform decision making in hospital services.
Inclusion criteria:
The review included studies on participants 18 years or over infected by Klebsiella pneumoniae carbapenemase who had undergone antimicrobial therapy in hospital and acute care services. Studies that compared the cost-effectiveness of different antimicrobials therapy for Klebsiella pneumoniae carbapenemase infection were included.
Outcome measures were costs 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 modelling 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 Joanna Briggs Institute (JBI) critical appraisal checklist for economic evaluations. Data was extracted from included studies using the standardized JBI data extraction tool. Data was 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 infection by Klebsiella pneumoniae carbapenemase. The results of this study demonstrated that there was no gold standard treatment for Klebsiella pneumoniae carbapenemase, 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.
Correspondence: Wendel Mombaque dos Santos, wendel@usp.br
EA is the Editor-in-Chief JBI Database of Systematic Reviews and Implementation Reports and was not involved in the editorial processing of this manuscript.
© 2019 by Lippincott williams & Wilkins, Inc.