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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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01-02-2020 | Probiotics | Review Article/Brief Review

Probiotics in hospitalized adult patients: a systematic review of economic evaluations

Authors: Vincent I. Lau, MD, FRCPC, Bram Rochwerg, MD, FRCPC, MSc, Feng Xie, PhD, Jennie Johnstone, MD, FRCPC, PhD, John Basmaji, MD, FRCPC, Jana Balakumaran, BSc, Alla Iansavichene, BSc, MLIS, Deborah J. Cook, MD, FRCPC, MSc

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 2/2020

Abstract

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.

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Title: Probiotics in hospitalized adult patients: a systematic review of economic evaluations
Authors: Vincent I. Lau, MD, FRCPC
Bram Rochwerg, MD, FRCPC, MSc
Feng Xie, PhD
Jennie Johnstone, MD, FRCPC, PhD
John Basmaji, MD, FRCPC
Jana Balakumaran, BSc
Alla Iansavichene, BSc, MLIS
Deborah J. Cook, MD, FRCPC, MSc
Publication date: 01-02-2020
Publisher: Springer International Publishing
Keywords: Probiotics
Antibiotic
Diarrhea
Clostridioides Difficile
Diarrhea
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 2/2020
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-019-01525-2

At a glance: The STEP trials

Springer Medicine

Probiotics in hospitalized adult patients: a systematic review of economic evaluations

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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