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Objectives: As part of the nationwide initiative to optimize antibiotic use and control antimicrobial resistance, many Chinese hospitals have started antimicrobial stewardship (AMS) programs. We conducted a study to understand the impact of AMS in China. Methods: A previously developed China-specific conceptual economic evaluation framework based on the U.S. Centers for Disease Control and Prevention guidelines and Chinese experts' feedback was used for this study. Data were collected from three tertiary teaching hospitals (bed size: 1159 to 2300) in Beijing (n=2) and Hunan (n=1). Hospital AMS coordinators responded to the evaluation questionnaire and follow-up calls/emails for data clarification. Data were analyzed in an Excel economic model developed based on the conceptual economic evaluation framework. Results: Among the three participating hospitals, core elements of the AMS programs included pre-authorization, "no indication, no treatment," post-operative antibiotic use monitoring, nosocomial infection reporting, and training programs. After implementing AMS (vs. pre-AMS), the average length of stay decreased in all three hospitals by 3.5% to 5.7%. Occupancy rates increased in two hospitals (2.5%, 6.1%) and decreased in the other (3.6%). Mortality rates decreased by approximately 14% in two hospitals and remained the same in the other hospital. The proportion of hospitalized patients receiving antimicrobial treatment decreased by 1.4% to 7.3%. The defined daily dose of antimicrobial drugs decreased by approximately 10% in two hospitals. Two hospitals reported the costs of implementing the AMS programs, including labor and equipment for susceptibility testing or laboratory data collection. All three hospitals experienced an increase in revenue (1.8% to 11.9%) and net benefit (23 to 139 million RMB). Conclusions: These findings indicate a positive impact of AMS on economic and clinical outcomes in these hospitals and provide insights into the costs and benefits that can be considered when implementing AMS in other Chinese hospitals.