OBJECTIVES: To determine the burden of carbapenem-resistant Gram-negative infections as a public health problem in Spain using Multi-Criteria Decision Analysis (MCDA).

METHODS: A panel of 9 multidisciplinary experts (1 preventive medicine specialist, 1 intensivist, 1 infectious diseases specialist, 1 microbiologist, 1 clinical pharmacologist, 2 hospital pharmacists and 2 regional and local health managers) assessed the burden of carbapenem-resistant Gram-negative infections in Spain. Adapted EVIDEM framework was used. After a literature review, an evidence matrix was developed for this health problem. Criteria were weighted by using an ordinal 5-points scale (1: not important; 5: very important). Each criterion was scored by the panel of experts and a reflective discussion of results was conducted.

RESULTS: “Efficacy/effectiveness of available treatments” was considered the most relevant criterion for evaluating the burden of carbapenem-resistant Gram-negative infections. “Type of therapeutic benefit” and “Specific interests” were excluded because they were not considered relevant for assessing the burden of this health problem. Carbapenem-resistant Gram-negative infections were perceived as a major public health problem with high clinical burden, important unmet needs and high economic costs (both direct and indirect). Current available treatments have an acceptable safety/tolerability profile and might have a positive impact on patients’ quality of life although evidence is mostly based on observational and retrospective studies. This public health problem was considered aligned with the Spanish National Health System (NHS) priorities. Different initiatives have been already developed to decrease the burden of this problem although there are still clinical and organizational aspects that need to be solved.

CONCLUSIONS: Carbapenem-resistant Gram-negative infections were considered a major public health problem for the Spanish NHS with important unmet needs to be yet satisfied, both at a clinical and an organizational level. MCDA might help stakeholders to determine the burden of challenging health problems or diseases considering clinical, economic, societal and contextual aspects.