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… Show more
“…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.…”
Section: Current Evidence On the Cost-effectiveness Of Ams Programmesmentioning
confidence: 99%
“…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].…”
Section: Current Evidence On the Cost-effectiveness Of Ams Programmesmentioning
confidence: 99%
“…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].…”
Section: Current Evidence On the Cost-effectiveness Of Ams Programmesmentioning
AIMS: This narrative review aimed to collate recent evidence on the cost-effectiveness and cost-benefit of antimicrobial stewardship (AMS) programmes, to address the question 'is AMS cost-effective?', while providing resources and guidance for future research in this area. SOURCES: PubMed was searched for studies assessing the cost-effectiveness, cost-utility or cost-benefit of AMS interventions in humans, published from January 2000 to March 2017, with no setting inclusion/exclusion criteria specified. Reference lists of retrieved reviews were searched for additional articles. CONTENT: Recent evidence on the cost-effectiveness and cost-benefit of AMS is described, studies suggest persuasive and structural AMS interventions may provide health economic benefits to the hospital setting. However, overall, cost-effectiveness evidence for AMS is severely limited, especially for the community setting. Recommendations for future research in this area are therefore provided, including discussion of appropriate health economic methodological choice. IMPLICATIONS: Health systems have a finite and decreasing resource, decision makers currently do not have necessary evidence to assess whether AMS programmes provide sufficient benefits. Although the evidence-base of the cost-effectiveness of AMS is increasing, it remains inadequate for investment decision-making. Robust health economics research needs to be completed to enhance the generalizability and usability of cost-effectiveness results
“…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.…”
Section: Current Evidence On the Cost-effectiveness Of Ams Programmesmentioning
confidence: 99%
“…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].…”
Section: Current Evidence On the Cost-effectiveness Of Ams Programmesmentioning
confidence: 99%
“…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].…”
Section: Current Evidence On the Cost-effectiveness Of Ams Programmesmentioning
AIMS: This narrative review aimed to collate recent evidence on the cost-effectiveness and cost-benefit of antimicrobial stewardship (AMS) programmes, to address the question 'is AMS cost-effective?', while providing resources and guidance for future research in this area. SOURCES: PubMed was searched for studies assessing the cost-effectiveness, cost-utility or cost-benefit of AMS interventions in humans, published from January 2000 to March 2017, with no setting inclusion/exclusion criteria specified. Reference lists of retrieved reviews were searched for additional articles. CONTENT: Recent evidence on the cost-effectiveness and cost-benefit of AMS is described, studies suggest persuasive and structural AMS interventions may provide health economic benefits to the hospital setting. However, overall, cost-effectiveness evidence for AMS is severely limited, especially for the community setting. Recommendations for future research in this area are therefore provided, including discussion of appropriate health economic methodological choice. IMPLICATIONS: Health systems have a finite and decreasing resource, decision makers currently do not have necessary evidence to assess whether AMS programmes provide sufficient benefits. Although the evidence-base of the cost-effectiveness of AMS is increasing, it remains inadequate for investment decision-making. Robust health economics research needs to be completed to enhance the generalizability and usability of cost-effectiveness results
“…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.…”
Section: Strategies Of Hospital Antimicrobial Stewardship Associated mentioning
confidence: 99%
“…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.…”
Section: Strategies Of Hospital Antimicrobial Stewardship Associated mentioning
do not themselves confer colistin resistance. Because all regions of the plasmid share a strong identity with plasmids isolated from colistinsensitive strains, it is unclear how novel resistance determinants are encoded. In summary, these data point to colistin-resistance conferred by an unidentified mcr-1-independent mechanism associated to a plasmid, which we fear could be spreading undetected around the globe. 3 We hope to be proven wrong.
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