Abstract
Objectives: We sought to determine the cost-effectiveness of Antimicrobial Stewardship Teams (ASTs) on the reduction of morbidity and mortality associated with nosocomial bacteraemia. Methods: A decision analytic model compared costs and outcomes of bacteraemic patients receiving standard treatment with or without an AST consult. Patients with a bacteraemic event during their hospital admission were included in the model. Effectiveness was estimated as quality-adjusted life years (QALYs) over the lifetime of patients. Model variables and costs, along with their distributions, were obtained from the literature and expert opinion. Incremental cost-effectiveness ratios (ICERs) were calculated to estimate the cost per QALY gained from the hospital perspective. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. The cost-effectiveness of clinical decision support systems was evaluated as a secondary analysis. Results: Implementing an AST for bacteraemia review cost $39 737 (95% CI $27 272-53 017) and standard treatment cost $39 563 (95% CI $27 164-52 797). The difference in effectiveness between the two strategies was 0.08 QALYs, and the base case ICER from the probabilistic analysis was $2367 per QALY gained [95% CI dominant (less costly, more effective) to $24 379]. Results from the probabilistic sensitivity analysis demonstrated there was more than a 90% likelihood that an AST would be cost-effective at a level of $10 000 per QALY. Conclusions: Maintaining an AST to improve care for bacteraemia is cost-effective from the hospital perspective. The estimate of $2367 per QALY gained for the AST intervention compares favourably with many currently funded healthcare interventions and services.
Original language | English (US) |
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Pages (from-to) | 816-825 |
Number of pages | 10 |
Journal | Journal of Antimicrobial Chemotherapy |
Volume | 63 |
Issue number | 4 |
DOIs | |
State | Published - 2009 |
Funding
We wish to thank Dr Robert Golub and Dr Beth Plunkett for their thoughtful comments regarding the study design and the TheraDoc Corporation for their unrestricted grant to fund this effort. This study was supported in part by a grant from TheraDoc Inc. TheraDoc provided support only to complete the project and was not involved in the following: design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation and review of the manuscript. M. H. S. was the principal investigator for the unrestricted grant provided by Theradoc Inc. to partially fund this effort. The authors of the study take full responsibility for all of the work detailed in the manuscript. No other conflicts of interest exist for any of the authors.
Keywords
- Antimicrobial stewardship programme
- Bacteraemia
- Bacteremia
- Clinical decision support
- Cost-benefit analysis
ASJC Scopus subject areas
- Pharmacology
- Microbiology (medical)
- Infectious Diseases
- Pharmacology (medical)