Economic evaluation of healthcare-associated infection prevention and control in long-term care: a systematic review protocol

Abstract

Background: Given the high risk of contracting a healthcare-associated infection in long-term care facilities, infection prevention and control are essential for the quality of care and safety of residents and staff. To develop more effective infection prevention and control interventions in long-term care facilities, it is important to assess the cost-effectiveness and cost-benefit of existing interventions. There are only a few reviews on this subject, but these are not recent and most do not perform an economic evaluation. Moreover, none uses a discounting approach which limits inter-study comparison. To address these gaps, we will conduct a systematic review of economic evaluations related to healthcare-associated infection prevention and control in long-term care facilities using a discounting approach.

Methods: We will query MEDLINE, Embase, Web of Science, Cochrane, CINAHL, EconLit, JSTOR, and Scopus, as well as the gray literature databases CORDIS and ProQuest. We will include quantitative studies that evaluate four clinical best practices associated with infection prevention and control (hand hygiene, hygiene and sanitation, screening, basic, and additional precautions) and use at least one of five economic analyses (cost-effectiveness, cost-benefit, cost-minimization, cost-utility, cost-consequences). Primary 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. Two co-authors will independently screen and select articles, extract data, and assess the quality of selected articles using the Scottish Intercollegiate Guidelines Network criteria, the Economic Evaluation criteria, and the Cochrane criteria for economic evaluation. Extracted data will be synthesized, and values will be adjusted to 2022 Canadian dollars using the discount rates of 3%, 5%, and 8%.

Discussion: Information obtained through this systematic review may help researchers and policy makers make more efficient use of limited healthcare resources to ensure the safety and quality of long-term care.

Systematic review registration: Research registry ID: reviewregistry1210.

Keywords: Benefit; Cost; Discount; Economic evaluation; Effectiveness; Healthcare-associated infection; Infection prevention and control; Long-term care facilities; Systematic review.

Fig. 1

Theoretical framework based on clinical best practices (CBPs)

Fig. 2

First round screening algorithm. Legend: ¹Reference does or does not have a title and/or abstract. ²Long-term care: nursing homes, assisted-living facilities, long-term care facilities, homes for the aged, and retirement homes. Excluded: acute care (e.g., hospitals, clinics). ³Population: all residents of long-term care facilities. Excluded: residents staying <72 h. ⁴Clinical best practices: hand hygiene, hygiene and sanitation, screening, and basic and additional precautions. Excluded: antibiotics and any other medications. ⁵Design: quantitative studies (controlled clinical trials, RCTs, cohort studies, longitudinal studies, follow-up studies, prospective studies, retrospective studies, cross-sectional studies, studies based on mathematical/statistical modelling, simulations). Excluded: qualitative studies, literature reviews (systematic reviews, meta-analyses, meta-syntheses, scoping reviews). ⁶Outcome: cost estimates of CBPs, incremental cost-effectiveness ratio, incremental cost per quality-adjusted life year, incremental cost per disability-adjusted life year and the incremental cost-benefit ratio, net costs and net cost savings. Excluded: technological assessments, purely clinical studies, pharmacological studies