A single hospital outbreak of the fungus *Candidozyma auris* can cost over £1 million to contain, and this project will systematically review which prevention and management strategies offer the best value for money. The fungus is a growing threat in the UK: it is often resistant to multiple drugs, kills a high proportion of infected patients, and survives for long periods on surfaces, making outbreaks hard to stop. Recent costly outbreaks in London and the South East, combined with the organism becoming notifiable in England in April 2025, have made this a top-priority question for the UK Health Security Agency. The researchers will first map the available evidence, then synthesise studies that report cost-effectiveness or resource use, such as length of hospital stay. If successful, the review will give NHS hospitals and care homes clear, evidence-based guidance on which outbreak strategies—such as screening, isolation, or cleaning protocols—are most cost-effective, helping to prevent future disruptions and reduce the financial burden on the health system.
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Candidozyma/Candida auris (C. auris) has rapidly emerged as a critical global health threat, capable of imposing costs exceeding £1 million to contain a single hospital outbreak and disrupting healthcare systems worldwide. Its designation by the World Health Organization (WHO) as a critical priority pathogen underscores its significance, which is driven by a dangerous combination of characteristics: frequent multidrug resistance, which limits treatment options; high mortality rates associated with invasive infections in some settings; and remarkable environmental persistence, which facilitates nosocomial transmission and makes outbreaks exceptionally difficult to control. In the United Kingdom, the threat posed by C. auris is increasing. The UK saw some outbreaks pre-COVID, which reduced during the pandemic because of restrictions on international travel but are on the rise again. Recent protracted and costly outbreaks in London and the South East have highlighted the severe economic and operational impact of this pathogen. In recognition of the escalating concern, C. auris was made a notifiable organism in England in April 2025, mandating formal reporting and signalling a new phase in the national public health response. This evidence synthesis will directly address a top-priority research question identified by the UK Health Security Agency (UKHSA). The overall objective of the project is to summarize the available evidence on the following question: "What is the cost-effectiveness of different outbreak prevention and management strategies for C. auris (acute and non-acute settings) undertaken internationally?" We will aim to carry out the review in two stages: a mapping review to establish the volume and type of available evidence followed by a more detailed synthesis of studies meeting the inclusion criteria. Studies reporting any measure of cost-effectiveness/value for money and/or resource use (e.g. length of hospital stay) will be included. Detailed inclusion criteria and methods for identifying and selecting relevant studies are included in the protocol.
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