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Objectives: Critically appraise published health economic models evaluating treatments of bacteria resistant to antibiotics, focusing on methicillin-resistant Staphylococcus aureus (MRSA) and extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae.

Methods: A structured literature review was conducted in Embase, identifying relevant publications by combining search facets for MRSA or ESBL, economic models, and antibiotics, excluding publications including the terms “animal” or “farm”. All search facets were search in the abstract and title, resulting in 40 publications. Two reviewers, blinded to the other’s initial evaluation, evaluated each of the titles and abstracts and found that 25 were relevant for a full review.

Results: The absolute majority of the identified studies presented cost-effectiveness models with a decision-analytic approach and a time horizon ranging from two to four weeks. The site of infection studied was dominated by nosocomial pneumonia as well as skin and soft tissue infections caused by MRSA. Only one model concerned gram-negative pathogens. No model was identified studying ESBL as the cause of infection. The most common antibiotic agents modelled were linezolid, vancomycin, daptomycin or their combination with a median of two treatment lines modelled. One model studies the cost-effectiveness of carbapenems. Sources used for informing antibiotic efficacy data were primarily published literature, clinical trials or clinical expert opinion. The most common outcome measures modelled were direct medical costs and resource utilization as well as efficacy measured by treatment success or antibacterial usage estimates. Four models (16%) included quality-adjusted life years (QALYs) as outcome measure.

Conclusions: The cost-effectiveness of linezolid and vancomycin for treatment of MRSA has been well-studied in various types of infections. There is a need for further cost-effectiveness and cost-benefit studies on antibiotic failure in more than two treatment lines, especially in carbapenem treatment of infections caused by ESBL, as these pose a significant resistance threat today.