Implementing an intensified antibiotic stewardship programme targeting daptomycin use in orthopaedic surgery: a cost–benefit analysis from the hospital perspective

Abstract

In this example of large endoprosthetic surgery department in a community-based hospital, the applied hospital ABS programme targeting daptomycin use has shown to be feasible, effective and beneficial compared to no intervention.

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

“…Fifty-five articles were found, resulting in six studies being included in this review [15e20]. Four studies calculated the costeffectiveness or costeutility of AMS programmes [15e18] (both cost-effectiveness and costeutility studies are referred to as 'costeffectiveness' studies from here onwards), whereas two additional studies calculated costebenefit [19,20]. Table 3 highlights the lack of evidence on the health economic benefit of restrictive AMS programmes, with all evidence found investigating persuasive or structural programmes (as defined in Table 1).…”

“…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.…”

“…The two costebenefit studies estimated policies including AMS programmes to be cost-saving, with estimates of cost-savings of V2575 per month for hospitals and $2.5 billion for Medicare [19,20]. However, the former study did not seem to account for all benefits in monetary terms and did not provide a costebenefit ratio [20]. This study instead compared direct healthcare costs (of antibiotics, cultures and the intervention) and discussed health gain in parallel [20].…”

“…However, the former study did not seem to account for all benefits in monetary terms and did not provide a costebenefit ratio [20]. This study instead compared direct healthcare costs (of antibiotics, cultures and the intervention) and discussed health gain in parallel [20]. The costebenefit evaluation of Clostridium difficile infection control measures did create a model that incorporated labour costs, illness costs and excess length of stay in its cost estimation, though it did not evaluate AMS alone [19].…”

Top 1% of Inpatients Administered Antimicrobial Agents Comprising 50% of Expenditures: A Descriptive Study and Opportunities for Stewardship Intervention

“…[5][6][7][8][9] A collateral benefit to improved antimicrobial use in the inpatient setting is limiting antimicrobial expenditures. [10][11][12][13][14] For example, Standiford and colleagues 15 demonstrated that implementation of a robust ASP in a large, tertiary academic medical center resulted in a 46% reduction in antimicrobial cost per 1,000 patient-days. However, maintenance of such programs is key as there was a 32% cost increase within 2 years of discontinuation of the program.…”