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. 2019 Feb 12:8:35.
doi: 10.1186/s13756-019-0471-0. eCollection 2019.

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Dilip Nathwani  1 , Della Varghese  2 , Jennifer Stephens  2 , Wajeeha Ansari  3 , Stephan Martin  2 , Claudie Charbonneau  4
Affiliations

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Dilip Nathwani et al. Antimicrob Resist Infect Control. .

Abstract

Background: Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs.

Methods: An update to the Dik et al. systematic review (2000-2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014-31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs.

Results: One hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500-1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were $732 per patient (range: $2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions.

Conclusions: Our data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower- and middle-income countries is limited and requires urgent attention.

Keywords: Antibiotic stewardship program; Antimicrobial resistance; Antimicrobial stewardship; Economic evaluation.

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Conflict of interest statement

Not applicable.Not applicable.At the time this manuscript was completed Ansari W and Charbonneau C were employees of Pfizer, Inc. Nathwani D is a key opinion leader on the topic of antimicrobial stewardship and a paid consultant for Pfizer Inc. Stephens J is a health economic consultant and is a managing partner and co-owner of Pharmerit International. Varghese D and Martin S were employees of Pharmerit International who were paid consultants in connection with this study.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA chart of the search method
Fig. 2
Fig. 2
Effect of ASP on Total Antimicrobial Usage. SM = Significance measured; SNM = significance not measured. *Total usage of antibiotics decreased in a majority of studies, as measured by drug dose, duration of therapy, proportion of patients receiving antibiotic therapy, or other outcomes
Fig. 3
Fig. 3
Conceptual value framework for implementation
See this image and copyright information in PMC

References

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