A cost-effectiveness analysis of two different antimicrobial stewardship programs

Abstract

There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial stewardship programs and had 30-day mortality as main outcome. Selected costs included: workload, cost of defined daily doses, length of stay, laboratory and imaging resources used to diagnose infections. Data were analyzed by deterministic and probabilistic sensitivity analysis to assess model's robustness, tornado diagram and Cost-Effectiveness Acceptability Curve. Bundled Strategy was more expensive (Cost difference US$ 2119.70), however, it was more efficient (US$ 27,549.15 vs 29,011.46). Deterministic and probabilistic sensitivity analysis suggested that critical variables did not alter final Incremental Cost-Effectiveness Ratio. Bundled Strategy had higher probabilities of being cost-effective, which was endorsed by cost-effectiveness acceptability curve. As health systems claim for efficient technologies, this study conclude that Bundled Antimicrobial Stewardship Program was more cost-effective, which means that stewardship strategies with such characteristics would be of special interest in a societal and clinical perspective.

Is antimicrobial stewardship cost-effective? A narrative review of the evidence

“…Two studies within the 'structural' category evaluated the cost-effectiveness of rapid diagnostics, whereas the other investigated the implementation of an AMS team [16e18]. The remaining studies included in this review evaluated multiple AMS programmes together, making it hard to disentangle what was driving the cost-effectiveness/costebenefit of these bundled interventions [15,19,20]. There was no evidence found evaluating AMS in the community or long-term care setting, with all studies evaluating AMS in hospitals.…”

“…There was no evidence found evaluating AMS in the community or long-term care setting, with all studies evaluating AMS in hospitals. Additionally, despite AMR being a global issue that could severely impact low-and middle-income countries [1], only one study explored the cost-effectiveness/costebenefit of AMS outside the 'western' world [15].…”

“…One study investigating antifungal stewardship did not state clearly how the estimate of $415 net saving per patient was derived, but did state that only drug costs and diagnostic costs were taken into account, meaning that this may not be a true costeffectiveness study (as stated by authors) but rather a cost comparison [18] (which compares only costs and has no evaluation of benefits -as defined in Table 2). Only one of the cost-effectiveness studies included utility in their effectiveness measure (estimating cost per QALY) [16], whereas two others included mortality as their effectiveness measure [15,17].…”

Strategies of hospital antimicrobial stewardship associated with different health outcomes

“…4 To illustrate this scenario, a Markov Chain Monte Carlo simulation was done to assess whether an active ASP would be more cost-effective than a policy-restricting and telephonebased stewardship. 5 Variables included in the simulation were costs of number of professionals involved with each ASP strategy, costs of antimicrobials, costs of length of stay, and clinical outcomes (30 day mortality). 5 Despite results being positive (active ASP was probabilistically more cost-effective than the other strategy), the study was only single centred and further studies in other settings are needed to assess its external validity.…”

“…To conclude, "...restrictive and persuasive strategies to improve appropriate antimicrobial use...", might promote the quality of antibiotics use in hospitals. 1 However, an "active strategy-based" ASP 2 that delineates care plans with hospitals' prescribers might be associated with even better clinical 3 and economic 5 results.…”