JAC Advance Access originally published online on February 6, 2009
Journal of Antimicrobial Chemotherapy 2009 63(4):816-825; doi:10.1093/jac/dkp004
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Original research |
Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infections: a probabilistic analysis
1 Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA 2 Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA 3 Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA 4 Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA 5 Institute for Healthcare Studies and Division of General Internal Medicine, Chicago, IL, USA 6 Centre for Management of Complex Chronic Care, Hines VA Hospital, Hines, IL, USA
Received 2 September 2008; returned 31 October 2008; revised 16 December 2008; accepted 31 December 2008
* Corresponding author. Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA. Tel: +1-630-515-6116; Fax: +1-630-515-6958; E-mail: mscheetz{at}nmh.org
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.
Keywords: cost–benefit analysis , bacteraemia , bacteremia , antimicrobial stewardship programme , clinical decision support