title: A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance.
abstract: Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain.
  
  
  
  We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative.
  
  
  
  According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions.
  
  
  
  The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.
authors.affiliation: Infectious Diseases Research Unit, Department of Clinical Sciences, Malmö, Lund University, Rut Lundskogs gata 3, plan 6, 20502, Malmö, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Lanbeck
authors.affiliation: IHE, The Swedish Institute for Health Economics, PO Box 2127, SE-220 02, Lund, Sweden.
authors.forename: Gunnel
authors.initials: G
authors.lastname: Ragnarson Tennvall
authors.affiliation: Infectious Diseases Research Unit, Department of Clinical Sciences, Malmö, Lund University, Rut Lundskogs gata 3, plan 6, 20502, Malmö, Sweden. fredrik.resman@med.lu.se.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Resman
mesh_terms: D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D004352:Drug Resistance, Microbial; D006801:Humans; D016357:Infection Control Practitioners / Q000191:economics / Q000706:statistics & numerical data*; D007239:Infections / Q000188:drug therapy* / Q000191:economics; D007902:Length of Stay; D015995:Prevalence; D013038:Specialization; D013548:Sweden
chemical_list: D000890:Anti-Infective Agents
keywords: Antimicrobial resistance; Antimicrobial stewardship; Costs; Economics