%0 Journal Article %1 scheetz_cost-effectiveness_2009 %A Scheetz, Marc H %A Bolon, Maureen K %A Postelnick, Michael %A Noskin, Gary A %A Lee, Todd A %D 2009 %J The Journal of Antimicrobial Chemotherapy %K Agents, Analysis, Bacteremia, Consultation, Drug Humans, Outcome Referral Treatment Utilization, and {Anti-Bacterial} {Cost-Benefit} %N 4 %P 816--825 %R 10.1093/jac/dkp004 %T Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infections: a probabilistic analysis %U http://www.ncbi.nlm.nih.gov/pubmed/19202150 %V 63 %X 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.

@article{scheetz_cost-effectiveness_2009, abstract = {{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.}, added-at = {2011-03-11T10:05:34.000+0100}, author = {Scheetz, Marc H and Bolon, Maureen K and Postelnick, Michael and Noskin, Gary A and Lee, Todd A}, biburl = {https://www.bibsonomy.org/bibtex/2239df16be1004835964f320d42ace01e/jelias}, doi = {10.1093/jac/dkp004}, interhash = {2614182e7b92793264c0858aadf20e73}, intrahash = {239df16be1004835964f320d42ace01e}, issn = {1460-2091}, journal = {The Journal of Antimicrobial Chemotherapy}, keywords = {Agents, Analysis, Bacteremia, Consultation, Drug Humans, Outcome Referral Treatment Utilization, and {Anti-Bacterial} {Cost-Benefit}}, month = apr, note = {{PMID:} 19202150}, number = 4, pages = {816--825}, shorttitle = {Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infections}, timestamp = {2011-03-11T10:06:20.000+0100}, title = {Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infections: a probabilistic analysis}, url = {http://www.ncbi.nlm.nih.gov/pubmed/19202150}, volume = 63, year = 2009 }