Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infections: a probabilistic analysis
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The Journal of Antimicrobial Chemotherapy 63 (4): 816--825 (April 2009)PMID: 19202150.

OBJECTIVES: We sought to determine the cost-effectiveness of Antimicrobial Stewardship Teams (ASTs) on the reduction of morbidity and mortality associated with nosocomial bacteraemia. METHODS: A decision analytic model compared costs and outcomes of bacteraemic patients receiving standard treatment with or without an AST consult. Patients with a bacteraemic event during their hospital admission were included in the model. Effectiveness was estimated as quality-adjusted life years (QALYs) over the lifetime of patients. Model variables and costs, along with their distributions, were obtained from the literature and expert opinion. Incremental cost-effectiveness ratios (ICERs) were calculated to estimate the cost per QALY gained from the hospital perspective. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. The cost-effectiveness of clinical decision support systems was evaluated as a secondary analysis. RESULTS: Implementing an AST for bacteraemia review cost \$39,737 (95\% CI \$27,272-53, 017) and standard treatment cost \$39,563 (95\% CI \$27,164-52,797). The difference in effectiveness between the two strategies was 0.08 QALYs, and the base case ICER from the probabilistic analysis was \$2367 per QALY gained 95\% CI dominant (less costly, more effective) to \$24,379. Results from the probabilistic sensitivity analysis demonstrated there was more than a 90\% likelihood that an AST would be cost-effective at a level of \$10,000 per QALY. CONCLUSIONS: Maintaining an AST to improve care for bacteraemia is cost-effective from the hospital perspective. The estimate of \$2367 per QALY gained for the AST intervention compares favourably with many currently funded healthcare interventions and services.
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