Major Tasks: 

• Analysis on the effectiveness of the different intervention programmes on primary and secondary outcomes; cost effectiveness analysis based on existing evidence (updated SR) from high-income countries and results of clinical trials; and developing evidence base for extrapolation to LMIC. 

Key Objectives:

• Estimate costs and health benefits associated with the interventions, including estimation of quality of life impact of infections.

• Perform cost-effectiveness evaluations accounting for heterogeneity based on the clinical trial results.

• Perform cost-effectiveness evaluations beyond the trial duration incorporating the impact on resistance and its health and cost consequences in the long term.

• Conduct budget-impact analyses to provide estimates of affordability of tested interventions in different settings.

• Identify potential barriers and facilitators of implementation in two selected low-and-middle-income countries.

Umbrella Review:
An umbrella review (i.e., a review of reviews) of economic evaluations of interventions for the prevention and clinical management of healthcare-associated infections (HCAIs) in hospitals, with a particular focus on infections resistant to antibiotics, is ongoing. 

The review will provide an up-to-date overview of the cost-effectiveness of the different interventions on trial within the REVERSE project - which include antimicrobial stewardship (ABS), infection prevention and control (IPC), and microbiology and diagnostic stewardship (MDS) – and guide decision-makers in identifying the interventions that offer the best value for money.

HCAIs lead to an increase in morbidity, bed occupancy, length of hospital stay, and mortality. HCAIs may also be resistant to antibiotics, making them harder to treat, leading to worse outcomes. 

There is a clear need for cost-effectiveness evidence to support decision-making on the most appropriate interventions for the prevention and clinical management of HCAIs, and infections resistant to antibiotics, in the context of limited healthcare budgets.

The findings of this review will directly inform specific parameters and modelling approaches for the cost-effectiveness analysis in the REVERSE project. 

A protocol for the umbrella review has been registered on PROSPERO, and the team are expected to submit a manuscript to a peer-reviewed journal by the end of the summer.