Defining the decision problem: a scoping review of economic evaluations for Clostridioides difficile interventions.

Antimicrobial Stewardship Clostridioides Clostridioides difficile Clostridium Infections / diagnosis Cost-Benefit Analysis Humans
Clostridioides difficile infection Economic evaluation Health technology assessment Prevention Scoping review

Journal

The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166

Informations de publication

Date de publication:
Mar 2022
Historique:
received: 06 10 2021
accepted: 16 11 2021
pubmed: 24 11 2021
medline: 8 3 2022
entrez: 23 11 2021
Statut: ppublish

Résumé

Clostridioides difficile infection is the leading cause of healthcare-associated infectious diarrhoea. Several preventative and treatment interventions exist; however, decisions for their use are typically made independent of other interventions along the care pathway. To assess how the scope of the decision problem is defined in economic evaluations of C. difficile interventions. A scoping review was conducted following the Joanna Briggs Institute framework using a comprehensive literature search with C. difficile and economic evaluation as key search concepts. Study selection and extraction were performed independently by two reviewers. An in-depth analysis of all cost-utility and cost-effectiveness analyses was conducted. Care pathway domains (i.e. infection prevention and control, antimicrobial stewardship programmes, prevention, diagnostics, treatment) were defined iteratively, and each study was classified according to the scope of the decision problem: (i) one intervention, one domain; (ii) one intervention, multiple domains; (iii) multiple interventions, one domain; and (iv) multiple interventions, multiple domains. In total, 3886 studies were identified. Of these, 116 studies were included in the descriptive overview, and 46 were included in the in-depth analysis. Most studies limited the scope of the decision problem to one intervention (43/46; 93%). Only three studies (3/46; 7%) assessed multiple interventions - either as bundled vs standalone interventions for prevention (i.e. a single domain), or as sequences of treatments for initial and recurrent infection (i.e. multiple domains). No study assessed multiple interventions across prevention and treatment domains. Economic evaluations for C. difficile infection assess narrowly defined decision problems which may have implications for optimal healthcare resource allocation.

Sections du résumé

BACKGROUND BACKGROUND
Clostridioides difficile infection is the leading cause of healthcare-associated infectious diarrhoea. Several preventative and treatment interventions exist; however, decisions for their use are typically made independent of other interventions along the care pathway.
AIM OBJECTIVE
To assess how the scope of the decision problem is defined in economic evaluations of C. difficile interventions.
METHODS METHODS
A scoping review was conducted following the Joanna Briggs Institute framework using a comprehensive literature search with C. difficile and economic evaluation as key search concepts. Study selection and extraction were performed independently by two reviewers. An in-depth analysis of all cost-utility and cost-effectiveness analyses was conducted. Care pathway domains (i.e. infection prevention and control, antimicrobial stewardship programmes, prevention, diagnostics, treatment) were defined iteratively, and each study was classified according to the scope of the decision problem: (i) one intervention, one domain; (ii) one intervention, multiple domains; (iii) multiple interventions, one domain; and (iv) multiple interventions, multiple domains.
RESULTS RESULTS
In total, 3886 studies were identified. Of these, 116 studies were included in the descriptive overview, and 46 were included in the in-depth analysis. Most studies limited the scope of the decision problem to one intervention (43/46; 93%). Only three studies (3/46; 7%) assessed multiple interventions - either as bundled vs standalone interventions for prevention (i.e. a single domain), or as sequences of treatments for initial and recurrent infection (i.e. multiple domains). No study assessed multiple interventions across prevention and treatment domains.
CONCLUSIONS CONCLUSIONS
Economic evaluations for C. difficile infection assess narrowly defined decision problems which may have implications for optimal healthcare resource allocation.

Identifiants

DOI: 10.1016/j.jhin.2021.11.010 PMID: 34813872
pubmed: 34813872
pii: S0195-6701(21)00408-4
doi: 10.1016/j.jhin.2021.11.010
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

22-31

Informations de copyright

Copyright © 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Auteurs

M Richardson (M)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: marina.richardson@mail.utoronto.ca.

A Erman (A)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

N Daneman (N)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

F A Miller (FA)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

B Sander (B)

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

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Classifications MeSH

questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Assurance de la qualité des soins de santé › Bilan opérationnel › Revue des pratiques de prescription des médicaments › Gestion responsable des antimicrobiens › Defining the decision problem: a scoping...
questionsmedicales.fr › Bactéries › Firmicutes › Clostridiales › Clostridioides › Defining the decision problem: a scoping...
questionsmedicales.fr › Bactéries › Firmicutes › Clostridiales › Clostridioides › Clostridium difficile › Defining the decision problem: a scoping...
questionsmedicales.fr › Infection › Infections bactériennes et mycoses › Infections bactériennes › Infections bactériennes à Gram positif › Infections à Clostridium › Defining the decision problem: a scoping...
questionsmedicales.fr › Organisations et économie des soins de santé › Économie › Coûts et analyse des coûts › Analyse coût-bénéfice › Defining the decision problem: a scoping...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Defining the decision problem: a scoping...