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Cost-Effectiveness of Antimicrobial Stewardship
An active antimicrobial stewardship program at an academic medical center was found to be highly cost-effective.
The increasing prevalence of antimicrobial-resistant microorganisms and the rising costs of medical care have led many institutions to consider developing active antimicrobial stewardship programs (ASPs). Given the up-front personnel expenses required to initiate such programs, return on investment remains a concern.
An ASP was in place at the University of Maryland Medical Center for 7 years. It was centered on an antimicrobial monitoring team that included an infectious diseases–trained clinical pharmacist and a part-time infectious diseases physician. Investigators recently analyzed the effects of this program on antimicrobial utilization costs.
Between the year before ASP implementation (fiscal year [FY] 2001) and the final year of the program (FY 2008), the institutional antimicrobial utilization costs per 1000 patient days were reduced by 45.8% — from US$44,181 to $23,933. An institutional cost savings of $2,949,705 was seen during the first 3 years of the program, with savings achieved through decreased use of antifungal and antibacterial agents and switching from intravenous to oral delivery. Defined daily doses of antimicrobial agents were also reduced significantly between FY 2004 (the first period with available data) and FY 2008.
After the program was discontinued, antimicrobial utilization costs per 1000 patient days increased to $27,833 in FY 2009 and $31,653 in FY 2010. Institutional antimicrobial utilization costs rose by $1,000,000 in FY 2009 and by an additional $873,184 in FY 2010. No significant changes were seen in length of stay, readmissions, mortality, or drug-related group case mix index over the 10-year study period.
Comment: The potential benefits of antimicrobial stewardship are likely dependent on the personnel involved and the changing costs of antimicrobial agents, and they will be influenced by the advent of more-robust electronic medical record systems. Still, these findings offer a compelling justification for academic medical centers, in particular, to institute ASPs. The authors note that, on the basis of cost-effectiveness data, an ASP has now been reimplemented at their institution.
— Richard T. Ellison III, MD
Published in Journal Watch Infectious Diseases March 21, 2012
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