Where is the evidence for cost-effectiveness of strategies to prevent or manage Candidozyma auris outbreaks in acute and non-acute settings? A systematic review of studies from high-income countries and evidence map [version 1; peer review: awaiting peer review]

Background

Candiozyma auris (C. auris) is an emerging, multidrug-resistant fungal pathogen causing severe healthcare-associated outbreaks. While the clinical and economic burdens are substantial, decision-makers in the UK face a paucity of robust economic evidence to guide resource allocation for effective infection prevention and control (IPC). Therefore, this review aimed to systematically map and synthesise international evidence from high-income settings on the economic impact and cost-effectiveness of IPC interventions for C. auris outbreaks to inform the UK health protection strategy.

Methods

A systematic review and evidence gap map were conducted following PRISMA guidelines. Eight databases and grey literature were searched for studies published between 2015 and 2025. Methodological quality was assessed using the Joanna Briggs Institute checklist. Two distinct narrative synthesis were conducted: 1) for the studies meeting systematic review criteria, and 2) studies include in the gap map.

Results

In total, five studies met the inclusion criteria for the systematic review, and additional six studies were included in the evidence map. Evidence originated mainly from acute hospital settings. Findings indicate that universal screening is unlikely to be cost-effective in low-prevalence settings, such as the UK. However, in higher-prevalence or targeted high-risk environments, rapid diagnostics significantly reduced result turnaround times and generating substantial system-wide savings.

Discussion

The cost-effectiveness of C. auris screening heavily depends on local prevalence and patient risk profiles. Strategies that rapidly detect and isolate patients provide critical operational and financial benefits by preventing extended hospitalisations. Current economic evidence for C. auris IPC is limited but supports targeted screening and rapid diagnostics to offset exorbitant outbreak management costs. Future UK-specific economic modelling must adopt a comprehensive healthcare perspective, prioritising the urgent need for research in non-acute settings.