Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infections: a probabilistic analysis.
OBJECTIVE
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.
Scheetz
Marc H
MH
Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA. mscheetz@nmh.org
Bolon
Maureen K
MK
Postelnick
Michael
M
Noskin
Gary A
GA
Lee
Todd A
TA
D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology / Q000401:mortality; D003362:Cost-Benefit Analysis; D004363:Drug Utilization / Q000191:economics*; D006801:Humans; D012017:Referral and Consultation / Q000191:economics*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents