Cost-Minimization Model of a Multidisciplinary Antibiotic Stewardship Team Based on a Successful Implementation on a Urology Ward of an Academic Hospital

Abstract

BackgroundIn 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.MethodsEffects 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.ResultsOne 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.ConclusionsThe 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.

The knowledge, attitude and practice of health practitioners towards antibiotic prescribing and resistance in developing countries—A systematic review

“…However, clinical diagnosis of bacterial infectious diseases could be challenging, especially in children, due to the nonspecific manifestation of symptoms and signs of infection in this age group . Thus, culture‐guided management of infectious diseases, as well as availability of experts in the area of infectious disease, would increase diagnostic certainty, a more rational antibiotic use, and save cost . Such efforts to streamline the use of antibiotics to promote a more rational approach are less common in developing countries when compared to developed countries …”

“…35,36 Thus, culture-guided management of infectious diseases, as well as availability of experts in the area of infectious disease, would increase diagnostic certainty, a more rational antibiotic use, and save cost. 33,37 Such efforts to streamline the use of antibiotics to promote a more rational approach are less common in developing countries when compared to developed countries. 8 Confidence on prescribing antibiotics was generally reported as high, but confidence on the selection of the correct antibiotic was reported as a problem by about half of the respondents from the studies by Gracia et al 17 and Quet et al 25 The limited availability or use of microbiology services in developing countries possibly contributes to the difficulty in selecting the correct antibiotic for definitive treatment.…”

Antimicrobial Stewardship Program at a tertiary teaching hospital in Vietnam: A longitudinal observational study

“…The ASP team meet monthly to review the overall antibiotic usage in all inpatients, and to discuss with junior physicians' appropriate antimicrobial strategy and deescalation therapy selection, and microbiology result interpretation [2]. We sought to apply the model of previously successful ASPs reported from developed countries, and then modified those to our local conditions [16].…”

“…This number will increase to as many as 10 million as a result of antimicrobial resistance, by the year 2050, by some estimates [1]. Antibiotic stewardship programs (hereinafter, ASP) are designed to optimize antimicrobial usage to improve patient care, limit antimicrobial resistance, and reduce overall healthcare costs [2,3]. ASP has been shown to reduce antimicrobial consumption by as much as 36%, and to provide annual cost reductions of up to 900,000 USD, in the past [4].…”

Automatic day-2 intervention by a multidisciplinary antimicrobial stewardship-team leads to multiple positive effects

“…Because there are considerable risks of acquiring a nosocomial infection with each extra day of hospitalization ( Rhame and Sudderth, 1981 ) and acquiring a catheter-related infection with each extra day of an intravenous line ( Sevinç et al, 1999 ; Chopra et al, 2013 ), changes in LOS and/or antimicrobial administration can have a large impact on the quality of care and patient safety. The direct return on investment for this A-Team has already been extensively evaluated separately, using the same patient groups, and found to be positive ( Dik et al, 2015a ). The clinical outcome measures in this study have been evaluated through an interrupted time-series analysis as well as through a quasi-experimental set-up, thereby providing an extensive evaluation of a set of clinically relevant parameters.…”