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

Abstract

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

Antibiotic stewardship: update and perspectives

“…They recommend using behavioural sciences to select the most promising interventions, based on a careful assessment of barriers and facilitators. As a useful complement, Naylor et al reviewed the cost-effectiveness of antimicrobial stewardship programmes [6]. Having found few studies in the literature, they make recommendations for future research.…”

Antimicrobial stewardship in hospitals in Latin America and the Caribbean: a scoping review

“…Regarding the outcome elements, in countries that lack data and resources, the value of ASPs is not always reported with metrics that allow for program assessment ( 33 ). Recently published reviews ( 34 – 36 ) showed that cost-effectiveness studies are most common in the United States and European countries. In fact, a recent review ( 34 ) showed that only one study of cost-effectiveness had been developed in LMICs.…”

Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England

“…This inventory was then refined through an iterative process, including a series of team virtual discussions and emails about its appropriateness. Data from 441 textual sources were then independently and systematically mapped and coded along three dimensions: a. type -mandatory requirements, recommendations, or national campaigns; b. method -restrictive, persuasive, and/or structural in nature [27], [28]; c. level of implementation -macro (national), meso (organisational), and/or micro (individual) levels. This was done independently and concurrently between the research teams.…”