title: Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting.
  
  
  METHODS
  A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses.
  
  
  RESULTS
  In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG.
  
  
  CONCLUSIONS
  Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided.
  
  
  CONCLUSIONS
  Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.
authors.affiliation: a Intensive Care Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Ruiz-Ramos
authors.affiliation: b Microbiology Department , Hospital Universitario y Politecnico La Fe , Valencia , Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Frasquet
authors.affiliation: c Pharmacy Department , Hospital Universitario y Politecnico La Fe , Valencia , Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Romá
authors.affiliation: c Pharmacy Department , Hospital Universitario y Politecnico La Fe , Valencia , Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Poveda-Andres
authors.affiliation: d Infectious Disease Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Salavert-Leti
authors.affiliation: a Intensive Care Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Castellanos
authors.affiliation: a Intensive Care Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Ramirez
mesh_terms: D000073602:Antimicrobial Stewardship / Q000191:economics* / Q000379:methods*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics; D003661:Decision Support Techniques; D004352:Drug Resistance, Microbial; D004469:Economics, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D008390:Markov Chains; D017059:Models, Econometric; D011014:Pneumonia / Q000188:drug therapy / Q000191:economics; D018805:Sepsis / Q000188:drug therapy / Q000191:economics; D013030:Spain
keywords: Anti-infective agents; Antimicrobial stewardship; Bacterial infection; Drug resistance