title: Cost-minimization model of a multidisciplinary antibiotic stewardship team based on a successful implementation on a urology ward of an academic hospital.
abstract: BACKGROUND
  In order to stimulate appropriate antimicrobial use and thereby lower the chances of resistance development, an Antibiotic Stewardship Team (A-Team) has been implemented at the University Medical Center Groningen, the Netherlands. Focus of the A-Team was a pro-active day 2 case-audit, which was financially evaluated here to calculate the return on investment from a hospital perspective.
  
  
  METHODS
  Effects were evaluated by comparing audited patients with a historic cohort with the same diagnosis-related groups. Based upon this evaluation a cost-minimization model was created that can be used to predict the financial effects of a day 2 case-audit. Sensitivity analyses were performed to deal with uncertainties. Finally, the model was used to financially evaluate the A-Team.
  
  
  RESULTS
  One whole year including 114 patients was evaluated. Implementation costs were calculated to be €17,732, which represent total costs spent to implement this A-Team. For this specific patient group admitted to a urology ward and consulted on day 2 by the A-Team, the model estimated total savings of €60,306 after one year for this single department, leading to a return on investment of 5.9.
  
  
  CONCLUSIONS
  The implemented multi-disciplinary A-Team performing a day 2 case-audit in the hospital had a positive return on investment caused by a reduced length of stay due to a more appropriate antibiotic therapy. Based on the extensive data analysis, a model of this intervention could be constructed. This model could be used by other institutions, using their own data to estimate the effects of a day 2 case-audit in their hospital.
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Jan-Willem H
authors.initials: JW
authors.lastname: Dik
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Certe Laboratory for Infectious Diseases, Groningen, the Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: Hendrix
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Alex W
authors.initials: AW
authors.lastname: Friedrich
authors.affiliation: Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Groningen, the Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Luttjeboer
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Prashant Nannan
authors.initials: PN
authors.lastname: Panday
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Kasper R
authors.initials: KR
authors.lastname: Wilting
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Lo-Ten-Foe
authors.affiliation: Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Groningen, the Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Bhanu
authors.initials: B
authors.lastname: Sinha
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D018803:Models, Economic; D009426:Netherlands; D012017:Referral and Consultation / Q000191:economics*; D014573:Urology Department, Hospital / Q000191:economics*
chemical_list: D000900:Anti-Bacterial Agents