Containing costs of antimicrobials in the hospital: a critical evaluation

Because reimbursement of hospitals from patient sources for the cost of antimicrobial agents varies considerably according to the nature of the patient population, the actual savings potential of cost-containment efforts is proportional to the extent that costs are not reimbursed. Meaningful cost estimations include calculations for drug preparation, administration, necessary laboratory tests, toxicity, and acquisition. Savings in surgical antimicrobial prophylaxis may be estimated according to the type and volume of operations, history of usage excesses, and anticipated degree of cooperation of surgeons. In therapy, savings generally derive from restricting use of costly drugs. Studies that demonstrate similar outcomes of patient care in restricted and unrestricted settings are presently lacking. Such studies are essential for programs that promote change from parenteral to oral antimicrobials, because they may shorten the length of hospitalization. The outcome of antimicrobial cost-containment efforts in patient care should be monitored as a surveillance activity to be conducted by infection control practitioners involved with quality assessment.