Developing a Modeling Framework for Quantifying the Health and Cost Implications of Antibiotic Resistance for Surgical Procedures.

IF 1.9 Q3 HEALTH CARE SCIENCES & SERVICES
Heather Davies, Joel Russell, Angel Varghese, Hayden Holmes, Marta O Soares, B Woods, Ruth Puig-Peiro, Stephanie Evans, Rory Tierney, Stuart Mealing, Mark Sculpher, Julie V Robotham
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引用次数: 2

Abstract

Background. Antimicrobial resistance (AMR) is a global public health threat. The wider implications of AMR, such as the impact of antibiotic resistance (ABR) on surgical procedures, are yet to be quantified. The objective of this study was to produce a conceptual modeling framework to provide a basis for estimating the current and potential future consequences of ABR for surgical procedures in England. Design. A framework was developed using literature-based evidence and structured expert elicitation. This was applied to populations undergoing emergency repair of the neck of the femur and elective colorectal resection surgery. Results. The framework captures the implications of increasing ABR by allowing for higher rates of surgical site infection (SSI) as the effectiveness of antibiotic prophylaxis wanes and worsened outcomes following SSIs to reflect reduced antibiotic treatment effectiveness. The expert elicitation highlights the uncertainty in quantifying the impact of ABR, reflected in the results. A hypothetical SSI rate increase of 14% in a person undergoing emergency repair of the femur could increase costs by 39% (-2% to 108% credible interval [CI]) and decrease quality-adjusted life-years by 11% (0.4% to 62% CI) over 15 y. Conclusions. The modeling framework is a starting point for addressing the implication of ABR on the outcomes and costs of surgeries. Due to clinical uncertainty highlighted in the expert elicitation process, the numerical outputs of the case studies should not be focused on but rather the framework itself, illustration of the evidence gaps, the benefit of expert elicitation in quantifying parameters with limited data, and the potential magnitude of the impact of ABR on surgical procedures. Implications. The framework can be used to support research surrounding the health and cost burden of ABR in England.

Highlights: The modeling framework is a starting point for assessing the health and cost impacts of antibiotic resistance on surgeries in England.Formulating a framework and synthesizing evidence to parameterize data gaps provides targets for future research.Once data gaps are addressed, this modeling framework can be used to feed into overall estimates of the health and cost burden of antibiotic resistance and evaluate control policies.

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开发一个模型框架,用于量化外科手术中抗生素耐药性对健康和成本的影响。
背景。抗菌素耐药性(AMR)是一个全球性的公共卫生威胁。抗生素耐药性的更广泛的影响,如抗生素耐药性(ABR)对外科手术的影响,还有待量化。本研究的目的是建立一个概念模型框架,为估计英国外科手术中ABR的当前和潜在未来后果提供基础。设计。使用基于文献的证据和结构化的专家启发开发了一个框架。这适用于接受股骨颈紧急修复和择期结肠直肠切除手术的人群。结果。随着抗生素预防效果的减弱,手术部位感染(SSI)发生率升高,该框架考虑到了ABR增加的影响,SSI后的预后恶化反映了抗生素治疗效果的降低。专家的启发强调了量化ABR影响的不确定性,反映在结果中。假设紧急股骨修复术患者SSI率增加14%,15年内成本增加39%(可信区间[CI] -2%至108%),质量调整生命年减少11% (CI 0.4%至62%)。建模框架是解决ABR对手术结果和成本影响的起点。由于专家引出过程中突出的临床不确定性,不应关注案例研究的数值输出,而应关注框架本身,证据差距的说明,专家引出在有限数据下量化参数的好处,以及ABR对外科手术的潜在影响程度。的影响。该框架可用于支持围绕英国ABR的健康和成本负担的研究。重点:建模框架是评估英格兰手术中抗生素耐药性对健康和成本影响的起点。制定一个框架和综合证据来参数化数据差距为未来的研究提供了目标。一旦数据缺口得到解决,该建模框架可用于对抗生素耐药性的健康和成本负担进行总体估计,并评估控制政策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
MDM Policy and Practice
MDM Policy and Practice Medicine-Health Policy
CiteScore
2.50
自引率
0.00%
发文量
28
审稿时长
15 weeks
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