Cost–utility analysis of antimicrobial stewardship programme at a tertiary teaching hospital in Ethiopia

Abstract

ObjectiveAntimicrobial stewardship (AMS) significantly reduces inappropriate antibiotic use and improves patient outcomes. In low-resource settings, AMS implementation may require concurrent strengthening of clinical microbiology capacity therefore additional investments. We assessed the cost-effectiveness of implementing AMS at Tikur Anbessa Specialised Hospital (TASH), a tertiary care hospital in Ethiopia.DesignWe developed a Markov cohort model to assess the cost–utility of pharmacist-led AMS with concurrent strengthening of laboratory capacity compared with usual care from a ‘restricted societal’ perspective. We used a lifetime time horizon and discounted health outcomes and cost at 3% annually. Data were extracted from a prospective study of bloodstream infections among patients hospitalised at TASH, supplemented by published literature. We assessed parameter uncertainty using deterministic and probabilistic sensitivity analyses.SettingTertiary care hospital in Ethiopia, with 800 beds and serves over half a million patients per year.PopulationCohort of adults and children inpatient population aged 19.8 years at baseline.InterventionLaboratory-supported pharmacist-led AMS compared with usual care. Usual care is defined as empirical initiation of antibiotic therapy in the absence of strong laboratory and AMS.Outcome measuresExpected life-years, quality-adjusted life-years (QALYs), costs (US$2018) and incremental cost-effectiveness ratio.ResultsLaboratory-supported AMS strategy dominated usual care, that is, AMS was associated with an expected incremental gain of 38.8 QALYs at lower expected cost (incremental cost savings:US$82 370) per 1000 patients compared with usual care. Findings were sensitive to medication cost, infection-associated mortality and AMS-associated mortality reduction. Probabilistic sensitivity analysis demonstrated that AMS programme was likely to be cost-effective at 100% of the simulation compared with usual care at 1%–51% of gross domestic product/capita.ConclusionOur study indicates that laboratory-supported pharmacist-led AMS can result in improved health outcomes and substantial healthcare cost savings, demonstrating its economic advantage in a tertiary care hospital despite greater upfront investments in a low-resource setting.

A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital

“…The implementation of diagnostic infrastructure and antimicrobial stewardship (AMS) is not cheap [ 47 ] and involves a range of different building stones [ 48 ]. However, it might be cost-effective, considering the high price associated with rising AMR rates and the subsequent morbidity and mortality [ 7 , 49 ]. Diagnostic services therefore need to be included into publically funded health care and not be dependent on patients’ ability to pay.…”

Antimicrobial Use-Related Problems Among Hospitalized Pediatric Patients: A Prospective Observational Study

“…Studies have reported that a high rate of antimicrobial use-related problems can be prevented by implementing rational antimicrobial use programs and implementing disease-specific treatment guidelines. 21 While the positive impact of antimicrobial stewardship programs on reducing inappropriate prescribing, cost, and antimicrobial resistance is well-documented, 1 , 32 it is essential to acknowledge the challenges faced in their implementation. Similar to numerous low- and middle-income countries, the implementation of antimicrobial stewardship in Ethiopia encounters challenges like limited awareness among healthcare professionals and the public, absence of standardized guidelines, and insufficient resources; addressing these issues requires comprehensive strategies involving education, policy development, improved access to diagnostic tools, and enhanced collaboration among stakeholders to ensure effective and sustainable antimicrobial use.…”

A qualitative study of barriers to antimicrobial stewardship in Indonesian hospitals: governance, competing interests, cost, and structural vulnerability

“…These included replacing the medicine with less effective ones, reducing the amount of medicine, and encouraging patients to pay for the medicine [ 52 ]. Evidence shows that diagnostic stewardship, culture-guided antibiotic treatment [ 53 , 54 ] and prophylaxis [ 55 ], increased cost-effectiveness i.e., decreased treatment and hospitalization expenditures [ 53 , 54 ]. However, the hospitals in this study did not monitor antibiotic and infection related expenditures, providing no rationale for either investing in AMS or asking for additional resources.…”