A Veterans’ Healthcare Administration (VHA) antibiotic stewardship intervention to improve outpatient antibiotic use for acute respiratory infections: A cost-effectiveness analysis
| Autor: | Katherine E. Fleming-Dutra, Karl Madaras-Kelly, Matthew H. Samore, Richard E. Nelson, Minkyoung Yoo, Ben Haaland, Jian Ying, McKenna Nevers, Adam L. Hersh |
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| Rok vydání: | 2021 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty Respiratory tract infections Epidemiology business.industry medicine.drug_class Cost-Benefit Analysis Antibiotics Psychological intervention Cost-effectiveness analysis Anti-Bacterial Agents Health administration Antimicrobial Stewardship Infectious Diseases Intervention (counseling) Outpatients Emergency medicine Humans Medicine Stewardship Antibiotic use business Respiratory Tract Infections Delivery of Health Care Veterans |
| Zdroj: | Infection Control & Hospital Epidemiology. 43:1389-1395 |
| ISSN: | 1559-6834 0899-823X |
| Popis: | Objectives:The Core Elements of Outpatient Antibiotic Stewardship provides a framework to improve antibiotic use, but cost-effectiveness data on implementation of outpatient antibiotic stewardship interventions are limited. We evaluated the cost-effectiveness of Core Element implementation in the outpatient setting.Methods:An economic simulation model from the health-system perspective was developed for patients presenting to outpatient settings with uncomplicated acute respiratory tract infections (ARI). Effectiveness was measured as quality-adjusted life years (QALYs). Cost and utility parameters for antibiotic treatment, adverse drug events (ADEs), and healthcare utilization were obtained from the literature. Probabilities for antibiotic treatment and appropriateness, ADEs, hospitalization, and return ARI visits were estimated from 16,712 and 51,275 patient visits in intervention and control sites during the pre- and post-implementation periods, respectively. Data for materials and labor to perform the stewardship activities were used to estimate intervention cost. We performed a one-way and probabilistic sensitivity analysis (PSA) using 1,000,000 second-order Monte Carlo simulations on input parameters.Results:The proportion of ARI patient-visits with antibiotics prescribed in intervention sites was lower (62% vs 74%) and appropriate treatment higher (51% vs 41%) after implementation, compared to control sites. The estimated intervention cost over a 2-year period was $133,604 (2018 US dollars). The intervention had lower mean costs ($528 vs $565) and similar mean QALYs (0.869 vs 0.868) per patient compared to usual care. In the PSA, the intervention was dominant in 63% of iterations.Conclusions:Implementation of the CDC Core Elements in the outpatient setting was a cost-effective strategy. |
| Databáze: | OpenAIRE |
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