A systematic literature review of the economic implications of acute bacterial skin and skin structure infections (ABSSSIs)

Objectives: During the years, acute bacterial skin and skin structure infections (ABSSSIs) have seen an increase in incidence in many parts of the western world. Additionally, the treatment of ABSSSIs, generally consisting of surgical debridement or drainage and empiric antibiotics in the hospital, can be further complicated by emerging multi drug resistant bacteria, most notably methicillin-resistant Staphylococcus aureus (MRSA). As the incidence rates increase alongside with rising antibiotic resistance, ABSSSIs are becoming a significant burden for healthcare systems. This study aims to collect evidence on the healthcare resource utilization of ABSSSI and the economic implications of different treatment modalities for the management of these diseases. Methods: A systematic literature search in MEDLINE, Cochane and ISPOR abstract databases with predefined inclusion criteria and subsequent quality assessment was performed. Results: The search identified 1,799 unique publications of which 26 contained relevant economic data on ABSSSIs treatment and were therefore included in this manuscript. There were six healthcare resource utilization studies, 11 cost analyses, three cost-minimization and six cost-effectiveness analyses, of which only a single study reported quality adjusted life years. Vancomycin was evaluated in most studies (21), followed by linezolid (15), daptomycin (8) and others (7). Conclusions: This review provides an in-depth overview of the economic implications of current ABSSSI management. Major cost drivers of ABSSSI treatment were length of hospital stay and the overall cost associated with frequent intravenous antibiotics administration. While most studies (20) applied a hospital perspective, there was a substantial disparity on the specific costs in- or excluded in the analysis, and on the unit prices. This led to significant variations of the final cost outcomes. Notably, over 10-fold differences were found. The overall quality and comparability of the literature reviewed was sub-optimal, elevating the need for more high-quality and reproducible economic evaluations in the area of ABSSSIs.