Purpose

Probiotics may prevent healthcare-associated infections, such as ventilator-associated pneumonia, Clostridioides difficile-associated diarrhea, and other adverse outcomes. Despite their potential benefits, there are no summative data examining the cost-effectiveness of probiotics in hospitalized patients. This systematic review summarized studies evaluating the economic impact of using probiotics in hospitalized adult patients.

Methods

We searched MEDLINE, EMBASE, CENTRAL, ACP Journal Club, and other EBM reviews (inception to January 31, 2019) for health economics evaluations examining the use of probiotics in hospitalized adults. Independently and in duplicate, we extracted data study characteristics, risk of bias, effectiveness and total costs (medications, diagnostics/procedures, devices, personnel, hospital) associated with healthcare-associated infections (ventilator-associated pneumonia, Clostridioides difficile-associated diarrhea and antibiotic-associated diarrhea). We used Grading of Recommendations Assessment, Development and Evaluation methods to assess certainty in the overall cost-effectiveness evidence.

Results

Of 721 citations identified, we included seven studies. For the clinical outcomes of interest, there was one randomized-controlled trial (RCT)-based health economic evaluation, and six model-based health economic evaluations. Probiotics showed favourable cost-effectiveness in six of seven (86%) economic evaluations. Three of the seven studies were manufacturer-supported, all which suggested cost-effectiveness. Certainty of cost-effectiveness evidence was very low because of risk of bias, imprecision, and inconsistency.

Conclusion

Probiotics may be an economically attractive intervention for preventing ventilator-associated pneumonia, Clostridioides difficile-associated diarrhea, and antibiotic-associated diarrhea in hospitalized adult patients. Nevertheless, certainty about their cost-effectiveness evidence is very low. Future RCTs examining probiotics should incorporate cost data to inform bedside practice, clinical guidelines, and healthcare policy.

Trial registration: PROSPERO CRD42019129929; Registered 25 April, 2019.

目的

益生菌可以预防医疗保健相关的感染，如呼吸机相关的肺炎，艰难梭菌相关的腹泻和其他不良后果。尽管它们具有潜在的好处，但尚无总结性数据检查益生菌在住院患者中的成本效益。该系统综述总结了评估在住院成人患者中使用益生菌的经济影响的研究。

方法

我们搜索MEDLINE，EMBASE，CENTRAL，ACP Journal Club和其他EBM评论（从成立到2019年1月31日）进行健康经济学评估，以检查住院成年人中使用益生菌的情况。我们独立并重复提取数据研究特征，偏倚风险，有效性和与医疗保健相关感染（呼吸机相关性肺炎，艰难梭菌相关性腹泻和治疗相关的总费用（药物，诊断/程序，设备，人员，医院））。抗生素相关性腹泻）。我们使用了建议评估，制定和评估的分级方法来评估总体成本效益证据的确定性。

结果

在确定的721次引用中，我们纳入了7项研究。对于感兴趣的临床结果，有一项基于随机对照试验（RCT）的健康经济评估，以及六项基于模型的健康经济评估。益生菌在七项经济评估中有六项（86％）显示出良好的成本效益。七项研究中有三项是由制造商支持的，所有这些都表明了成本效益。由于存在偏见，不精确和不一致的风险，因此成本效益证据的确定性非常低。

结论

益生菌可能是在住院成人患者中预防呼吸机相关性肺炎，艰难梭状芽胞杆菌相关性腹泻和抗生素相关性腹泻的经济上有吸引力的干预措施。然而，对其成本效益证据的确定性非常低。未来检查益生菌的RCT应纳入成本数据，以告知床边实践，临床指南和医疗保健政策。

试用注册： PROSPERO CRD42019129929；注册于2019年4月25日。