title: Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program.
abstract: BACKGROUND
  An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.
  
  
  METHODS
  A descriptive cost analysis before, during, and after the program.
  
  
  METHODS
  A large tertiary care teaching medical center.
  
  
  METHODS
  Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.
  
  
  RESULTS
  The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.
  
  
  CONCLUSIONS
  The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.
authors.affiliation: University of Maryland Medical Center, Baltimore, Maryland 21201, USA. hstandiford@umm.edu
authors.forename: Harold C
authors.initials: HC
authors.lastname: Standiford
authors.forename: Shannon
authors.initials: S
authors.lastname: Chan
authors.forename: Megan
authors.initials: M
authors.lastname: Tripoli
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Weekes
authors.forename: Graeme N
authors.initials: GN
authors.lastname: Forrest
mesh_terms: D000046:Academic Medical Centers / Q000191:economics* / Q000458:organization & administration; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D016527:Drug Costs; D017723:Drug Utilization Review; D006801:Humans; D008396:Maryland; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care
chemical_list: D000890:Anti-Infective Agents