Bianca C. Salvador, Federal University of Parana, Parana, Brazil, Rosa C. Lucchetta, University of Parana, Parana, Brazil, Flávia M. Sarti, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil, Fernando F. Ferreira, Department of Physics, School of Philosophy, Sciences, and Letters, University of São Paulo, São Paulo, Brazil, Esteban F. Tuesta, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil, Bruno S. Riveros, MAPESolutions, Parana, Brazil, Keite S. Nogueira, Clinical Hospital, Federal University of Parana, Parana, Brazil, Bernardo M.M. Almeida, Clinical Hospital, Federal University of Parana, Parana, Brazil, Helena H.L. Borba, Federal University of Parana, Parana, Brazil, Astrid Wiens, Federal University of Parana, Parana, Brazil.
Antimicrobial drug resistance is a serious worldwide public health problem, because of its high mortality rate and complex clinical management. Centers for Disease Control and Prevention, in 2013, estimated that more than 2 million infections per year were caused by resistant pathogens, 23.000 resulting in death. Therefore, in 2017, World Health Organization listed the global priority of antibiotic-resistant bacteria aiming to guide research. However, besides management difficulties, diagnostic by itself represents an important point of care. Following international guidelines, the conventional method demand days to weeks until the final result, on the other hand, molecular methods provide accurate and faster identification of resistant strains, but at higher costs.
The aim of this study was to perform a cost-effectiveness analysis (CEA) of the molecular diagnostic method associated with conventional diagnostic method compared with the conventional method alone, for the detection of resistant profile in bacteremia, from the perspective of the Brazilian Public Health System, in intensive care units. To achieve this goal, clinical parameters regarding methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Gram-negative bacteria (CRGNB), and vancomycin-resistant Enterococcus spp. (VRE) infections were collected from searches on PubMed, Scopus, and SciELO, using specific keywords, followed by building a dynamic model which allows CEA, calibrated and validated according to international recommendations. The incremental cost-effectiveness ratio of the associated methods (molecular and conventional) compared with the conventional alone was calculated using the outcomes “avoided death” and “avoided resistant infections.” Please read the full article here.