As we all enjoy Infection Prevention Week for 2025, I thought I’d take a look into the literature to see whether anybody has done some cost-effectiveness work for an IPC service as a whole. I came across this “Umbrella” review (i.e. a review of reviews!), which looks at the cost-effectiveness of interventions to tackle HCAI and AMR (to include IPC, AMS, diagnostic stewardship), and thought it was worth sharing. The bottom line: there’s a lot of cost-effectiveness evaluations for IPC interventions, most of which are cost-effective, but a bit of a gap around cost-effectiveness of the service as a whole.

The umbrella review published in the Journal of Hospital Infection includes findings from 24 systematic reviews to assess the cost-effectiveness of interventions aimed at preventing and managing HCAIs in adult hospital patients. The review focuses on three key intervention categories: antimicrobial stewardship (AMS), IPC, and microbiology and diagnostic stewardship.

Key findings

• Selective screening of high-risk patients or patient groups / settings emerged as the most consistently cost-effective strategy, especially when compared with universal screening or no intervention.
• IPC bundles, which combine multiple infection control measures (e.g., hand hygiene, environmental hygiene, PPE), were generally cost-effective, though the heterogeneity of interventions and unclear comparators in many studies limit how far we can generalise these findings.
• Environmental hygiene and hand hygiene interventions were found to be cost-effective compared to standard practice, though the evidence base was limited.
• Diagnostic interventions, including molecular and point-of-care testing, were also cost-effective, particularly for sepsis and respiratory infections.
• Surveillance strategies, such as whole-genome sequencing and electronic registries, demonstrated cost-effectiveness in high-prevalence settings.
• Education and training interventions yielded mixed outcomes. Simulation-based programs were effective, while national guidelines and local protocols varied in impact.
• PPE interventions showed inconsistent cost-effectiveness, with results highly dependent on infection type and healthcare setting.

Context

A recurring theme in the review is the importance of context such as infection prevalence, transmission dynamics, healthcare infrastructure, and willingness-to-pay thresholds, in determining cost-effectiveness. Interventions that are cost-effective in one setting may not be in another, underlining the need for local decision-making.

Future priorities

• Gram-negative infections, despite their growing public health threat, were underrepresented in the review, especially for CPE
• Many studies lacked clarity on comparators, making it difficult to assess relative effectiveness.
• The review highlights the need to disentangle the cost-effectiveness of individual components within bundled interventions.
• Future economic evaluations should incorporate both generic outcome measures (e.g., QALYs, DALYs) and condition-specific metrics to enable broader applicability.
• Whilst a lot of individual interventions and combinations of interventions have been evaluated, there’s a gap around the cost-effectiveness of a service as a whole.

Summary

This umbrella review provides a comprehensive synthesis of the cost-effectiveness landscape for HCAI interventions. While selective screening and bundled stand out, the findings emphasise the need for context-aware implementation and more detailed economic evaluations. As finances become tighter and tighter, seemingly by the day, developing the evidence base around effectiveness and cost-effectiveness is going to be ever-more important.