Jesus Ruiz-Ramos1, Juan Frasquet2, Eva Romá3, Jose Luis Poveda-Andres3, Miguel Salavert-Leti4, Alvaro Castellanos1, Paula Ramirez1. 1. a Intensive Care Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain. 2. b Microbiology Department , Hospital Universitario y Politecnico La Fe , Valencia , Spain. 3. c Pharmacy Department , Hospital Universitario y Politecnico La Fe , Valencia , Spain. 4. d Infectious Disease Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain.
Abstract
AIMS: To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. MATERIALS AND METHODS: A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. RESULTS: In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. LIMITATIONS: Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. CONCLUSIONS: Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.
AIMS: To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. MATERIALS AND METHODS: A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. RESULTS: In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. LIMITATIONS: Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. CONCLUSIONS: Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.
Entities:
Keywords:
Anti-infective agents; Antimicrobial stewardship; Bacterial infection; Drug resistance
Authors: E Esteve-Palau; S Grau; S Herrera; L Sorlí; M Montero; C Segura; X Durán; J P Horcajada Journal: Rev Esp Quimioter Date: 2018-03-09 Impact factor: 1.553
Authors: Maha Mahmoud Alawi; Wail A Tashkandi; Mohamed A Basheikh; Faten M Warshan; Hazem Ahmed Ghobara; Rosemarie B Ramos; Mary Leilani Guiriba; Omar Ayob; Safiah Saad Janah; Anees Ahmad Sindi; Suheib Ali Abdulhamid Ahmed; Salah Dammnan; Esam Ibraheem Azhar; Ali A Rabaan; Salma Alnahdi; Maged Mohammed Bamahakesh Journal: Interdiscip Perspect Infect Dis Date: 2022-04-12