Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units

Area of Science:

• Health Economics
• Infectious Diseases
• Critical Care Medicine

Background:

• Antimicrobial resistance (AMR) poses a significant global health threat, necessitating effective strategies to optimize antimicrobial use.
• Antimicrobial stewardship (AS) programs are crucial for combating AMR, particularly in high-risk settings like critical care units.

Purpose of the Study:

• To assess the cost-effectiveness of implementing an antimicrobial stewardship (AS) program in Spanish critical care units.
• To analyze the economic impact of AS programs on managing infections and reducing multidrug-resistant bacteria.

Main Methods:

• A decision model was developed to compare costs and outcomes of infections in critical care units with and without an AS program.
• The analysis adopted the perspective of the Spanish National Health System, including only direct costs.
• Probabilistic sensitivity analyses were conducted to evaluate uncertainty in cost-effectiveness ratios.

Main Results:

• Short-term implementation of an AS program yielded a net benefit of €71,738 by reducing antimicrobial consumption.
• The cost per avoided resistance was €7,342, and the cost per life-year gained (LYG) was €9,788.
• There was a >90% probability that an AS program would be cost-effective at €8,000 per LYG.

Conclusions:

• Antimicrobial stewardship programs in critical care are a long-term cost-effective investment.
• Implementation costs are offset by reduced antimicrobial consumption and prevention of multidrug-resistant infections.
• Further research is needed to fully understand the impact on patient outcomes and resistance reduction.