Economic evaluation of non-invasive liver tests for the diagnosis of liver fibrosis in chronic liver diseases: a systematic review protocol.

OBJECTIVE: The objective of this review is to determine the costs and benefits of non-invasive liver tests vs liver biopsy in patients with chronic liver diseases. INTRODUCTION: Hepatic diseases can lead to liver fibrosis, cirrhosis, and hepatocellular carcinoma. In the past, liver biopsy was the only option for diagnosing fibrosis degree. Liver biopsy is an invasive procedure that depends on the sample size to be able to deliver an accurate diagnosis. In recent years, non-invasive liver tests have been increasingly used to estimate liver fibrosis degree; however, there is a lack of economic assessments of technology implementation outcomes. INCLUSION CRITERIA: This review will include partial (cost studies) and complete economic evaluation studies on hepatitis B, hepatitis C, alcoholic liver disease, and non-alcoholic fatty liver disease that compare non-invasive liver tests with liver biopsies. Studies published in English, French, Spanish, German, Italian, or Portuguese will be included. No date limits will be applied to the search. METHODS: This review will identify published and unpublished studies. Published studies will be identified using MEDLINE (PubMed), Cochrane Library (CENTRAL), Embase, Web of Science, Scopus, and LILACS. Sources of unpublished studies and gray literature will include sources from health technology assessment agencies, clinical practice guidelines, regulatory approvals, advisories and warnings, and clinical trial registries, as well as Google Scholar. Two independent reviewers will screen and assess studies, and extract and critically appraise the data. Data extracted from the included studies will be analyzed and summarized to address the review objective using narrative text, and the JBI dominance ranking matrix. REVIEW REGISTRATION: PROSPERO CRD42023404278.

The impact of the SARS-CoV-2 pandemic on sickness absenteeism among hospital workers.

Introduction: Worker illness and, more recently, infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can manifest as sickness absence, considerably increasing absenteeism rates, which were already rising. Objectives: To determine the impact of the SARS-CoV-2 pandemic on sickness absence rates among hospital workers and on the costs associated with them. Methods: A cross-sectional study with 1,229 workers at a University Hospital in the South of Brazil. Data were collected from absenteeism records for the period from September 2014 to December 2020 held in the Occupational Health Service database. Data were analyzed using descriptive and inferential statistics. Results: The mean sickness absenteeism rate was 3.25% and a significant increase was observed during the pandemic (5.10%) when compared to the pre-pandemic period (2.97%) (p = 0.02). During the pandemic, the mean number of sickness absence days was 2.03 times greater and the mean daily cost increased 2.49 times. Administrative assistants had the lowest relative risk (RR) of infection (RR: 0.5120; 95% confidence interval [95%CI] 0.2628-0.9974). In turn, the nursing team (RR: 1.37; 95%CI 1.052-1.787), physiotherapists (RR: 1.7148; 95%CI 1.0434-2.8183), and speech therapists (RR: 2.7090; 95%CI 1.5550-4.7195) were at greatest risk of SARS-CoV-2 infection. Conclusions: The SARS-CoV-2 pandemic led to an increase in sickness absence among workers in a hospital setting. The nursing team, physiotherapists, and speech therapists were at greatest risk of SARS-CoV-2 infection.

Absenteeism-disease in health care workers in a hospital context in southern Brazil.

INTRODUCTION: Absenteeism is a pervasive and growing worldwide problem. In hospital settings, it is often associated with a fast-paced environment, shift work and high occupational demands. Absenteeism in hospitals can also be attributed to poor working conditions and the high emotional burden associated with daily exposure to illness and death. These conditions often lead to sickness absence. OBJECTIVES: To assess sickness absence among health care workers in hospital settings. METHODS: A cross sectional study was conducted using the data and medical records of health care workers in a hospital in Rio Grande do Sul, Brazil. The data covered the period of September 2014 to December 2018. RESULTS: The sample consisted of 559 workers, 233 of whom were absent for at least 1 day in the year. Sickness absence was most common among women (79%) and nursing technicians (45.5%). The mean duration of absence was 5.53 days (standard deviation: 20.42), and the sickness absence rate was 2.01%. The most common reasons for sickness absence were injury, poisoning and other consequences of external causes (20.19%), followed by mental and behavioral disorders (17.90%) and diseases of the musculoskeletal system and connective tissue (11.69%). CONCLUSIONS: Greater awareness of the factors associated with sickness absence in hospital settings can contribute to the planning of occupational health initiatives targeting the most vulnerable workers.

Cost-effectiveness of antimicrobial treatment for inpatients with carbapenem-resistant Klebsiella pneumoniae infection: a systematic review of economic evidence.

OBJECTIVES: The objective of this review was to evaluate the cost-effectiveness of antimicrobial therapy for patients with carbapenem-resistant Klebsiella pneumoniae infection. INTRODUCTION: Among the main multi-resistant microorganisms, carbapenem-resistant K. pneumoniae is responsible for the mortality of 40% of patients following 30 days of infection. Treatment for carbapenem-resistant K. pneumoniae infection entails the use of high-cost antimicrobials. Inappropriate use of antimicrobials can increase the cost of treatment fourfold. This review aimed to evaluate the cost-effectiveness of antimicrobial therapy treatment for patients with carbapenem-resistant K. pneumoniae infection to better inform decision making in hospital services. INCLUSION CRITERIA: The review included studies on participants 18 years or over with carbapenem-resistant K. pneumoniae infection who had undergone antimicrobial therapy in hospital and acute care services. Studies that compared the cost-effectiveness of different antimicrobial therapy for carbapenem-resistant K. pneumoniae infection were included. Outcome measures were cost per unit of effect expressed in clinical outcome units; this included cost per avoided death, cost per prevention of sepsis and cost per duration of stay. Economic studies with a cost-effectiveness design were considered, as well as modeling studies. METHODS: A three-step search strategy was utilized to locate studies published in English, Spanish or Portuguese, with no date restrictions. Two independent reviewers screened titles and abstracts and the full texts of potentially relevant studies for eligibility. Methodological quality was assessed by two independent reviewers using the JBI critical appraisal checklist for economic evaluations. Data were extracted from included studies using the standardized JBI data extraction tool. Data were synthesized using narrative, tables and the JBI Dominance Ranking Matrix. RESULTS: This review identified eight studies that evaluated the cost-effectiveness of different treatments for carbapenem-resistant K. pneumoniae infection. The results of this study demonstrated that there was no gold standard treatment for carbapenem-resistant K. pneumoniae infection, hence treatment was generally directed by colonization pressure and resistance profiles. Furthermore, due to the moderate quality and limited number of studies, there was high uncertainty of the values of the cost-effectiveness ratio. CONCLUSIONS: Ofloxacin appears to be the most cost-effective treatment; however, conclusions are limited due to the small number and low quality of studies.

Cost-effectiveness of the antimicrobial treatment for inpatients infected with Klebsiella pneumoniae carbapenemase: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to evaluate the cost-effectiveness of antimicrobial therapy treatment for inpatients infected with Klebsiella pneumoniae carbapenemase.More specifically, the review question is: What is the best evidence on the cost-effectiveness of the antimicrobial treatment for inpatients infected with Klebsiella Pneumoniae Carbapenemase?"