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Reduction in antibiotic costs by restricting use of an oral cephalosporin
Insights
Implementing infectious disease specialist consultations significantly reduced antibiotic costs. Requiring physicians to call specialists curbed cephalexin use, cutting overall antibiotic expenditure by 29% with minimal specialist effort.
Area of Science:
- Infectious Diseases
- Health Economics
- Antimicrobial Stewardship
Background:
- Antibiotic cost control is crucial but challenging, especially when requiring extensive infectious disease specialist (IDS) involvement.
- A municipal hospital identified high expenditure on oral cephalosporin, cephalexin, accounting for 31% of total antibiotic costs.
Purpose of the Study:
- To evaluate the effectiveness of different interventions in controlling antibiotic costs, specifically focusing on cephalexin use.
- To determine if direct specialist consultation is a feasible and effective method for antimicrobial stewardship.
Main Methods:
- A retrospective analysis of antibiotic cost data was conducted.
- Two interventions were compared: mandatory antibiotic justification forms versus direct telephone consultation with an IDS for cephalexin prescribing.
- Cost savings were adjusted for inflation.
Main Results:
- Mandatory justification forms did not significantly decrease cephalexin use.
- Requiring physicians to telephone an IDS for approval led to a marked restriction in cephalexin prescribing.
- This intervention was associated with a 29% reduction in total antibiotic costs (inflation-adjusted).
Conclusions:
- Direct consultation with infectious disease specialists can be a highly effective and low-effort strategy for controlling antibiotic costs.
- This approach achieved substantial cost savings with minimal specialist time, demonstrating a favorable cost-benefit ratio for antimicrobial stewardship programs.
Abstract:
Antibiotic cost control programs are important; however, they may be difficult to implement if they include intensive involvement of infectious diseases specialists. In a large municipal hospital, review of antibiotic cost data indicated that 31 percent of the total antibiotic expenditure was for an oral cephalosporin, cephalexin. The requirement that an antibiotic justification form be completed did not decrease use of the drug. However, the requirement that the prescribing physician telephone an infectious diseases specialist resulted in marked restriction of the oral cephalosporin and was accompanied by a 29 percent reduction (adjusted for inflation) in total antibiotic costs. Since comparatively few telephone requests were made and since the decision process to use an oral cephalosporin is comparatively simple, marked reduction in antibiotic costs was achieved with relatively little effort by the infectious disease expert.