Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections

Abstract

Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P Ͻ 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 Ϯ 16.5 days versus 14.2 Ϯ 16.7 days, P ϭ 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million.

Clinical impact of matrix‐assisted laser desorption ionization‐time of flight mass spectrometry combined with antimicrobial stewardship interventions in patients with bloodstream infections in a Japanese tertiary hospital

“…Compared with traditional biochemical methods, MALDI‐TOF MS offers substantially faster and more accurate identification of isolated organisms . Several studies have shown that MALDI‐TOF MS combined with an antimicrobial stewardship program (ASP) improves clinical outcomes in patients with positive blood cultures . However, in many hospitals around the world, ASPs are not in place because of restrictions on medical resources .…”

“…[6][7][8] Several studies have shown that MALDI-TOF MS combined with an antimicrobial stewardship program (ASP) improves clinical outcomes in patients with positive blood cultures. [8][9][10][11][12][13][14] However, in many hospitals around the world, ASPs are not in place because of restrictions on medical resources. 15 Furthermore, Jeon et al reported that evaluation using MALDI-TOF MS in the absence of an ASP does not improve clinical outcomes.…”

Impact of short-incubation MALDI-TOF MS on empiric antibiotic therapy in bloodstream infections caused by Pseudomonas aeruginosa, Enterococcus spp. and AmpC-producing Enterobacteriaceae

“…Combined with antimicrobial stewardship team intervention, it has been associated with reduced mortality and shorter hospital stay in patients with BSI (Huang et al, 2013). In addition, combined with antimicrobial stewardship team intervention, it has been shown to be cost-effective (Patel et al, 2016;Perez et al, 2013). MALDI-TOF analysis combined with a short subculture time of positive blood cultures (si-MALDI-TOF) is an improvement of this technique, allowing even shorter time to pathogen identification with a positive effect on antibiotic therapy (Idelevich et al, 2014;Kohlmann et al, 2015), and is also associated with reduced length of hospital stay and mortality in patients with BSI (Delport et al, 2017).…”

The Added Cost of Rapid Diagnostic Testing and Active Antimicrobial Stewardship: Is It Worth It?

“…But acquisition of MALDI-TOF MS and other RDTs would be greatly benefited by published data showing their benefit in patient outcomes and hospital cost savings. The publication by Patel et al in this issue of the Journal of Clinical Microbiology is the first report of a study designed to perform a comprehensive cost assessment for implementation of MALDI-TOF MS and active antimicrobial stewardship for bloodstream infections (16). In the preintervention group (n ϭ 247), traditional biochemical methods were used for bacterial identification, only Gram stain alert values were phoned to clinicians, and clinical pharmacists reviewed antimicrobial data daily Monday through Friday to optimize drug regimens, but that review did not occur in real time.…”

“…The amounts saved have been highly variable, likely due the differing costs of hospitalization at different institutions, the charges included in the analysis, and the bloodstream pathogens included in the study. In the publication by Patel et al, the authors performed a very thorough cost analysis that included fixed direct, variable direct, and fixed indirect costs broken down by 13 cost centers, which allowed a highly detailed comparison to be made between the pre-and postintervention groups (16). The cost of organism identification for traditional biochemical methods and the cost of MALDI-TOF MS were included in the pre-and postintervention costs, respectively.…”