Cost-effectiveness of infection prevention and control measures for carbapenem-resistant Gram-negative bacilli: A...

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.

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. Outcomes will include net cost savings, incremental cost-effectiveness ratio, incremental cost per quality-adjusted life-year, and incremental cost per disability-adjusted life-year. Each article will be screened by three coauthors independently. One coauthor and the generative artificial intelligence chatbot Elicit will independently perform data extraction using the Consolidated Health Economic Evaluation Reporting Standards. The extractions will then be reviewed by another co-author and compiled into a single document. Two coauthors will assess the quality of the studies using three quality assessment tools: the Scottish Intercollegiate Guidelines Network checklist for economic evaluations, the Drummond critical assessment for economic evaluations, and the Cochrane Handbook for Systematic Reviews of Interventions. We will calculate and report inter-rater agreement as a percentage. We will use The Dominance Ranking Matrix by the Joanna Briggs Institute to assess whether an intervention should be favoured or rejected, or if the results are unclear. Extracted data will be synthesised, and values will be adjusted to 2026 Canadian dollars using the discount rates of 3%, 5% and 8%. Sensitivity analyses will then be performed.

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