Lanbeck Peter, Ragnarson Tennvall Gunnel, Resman Fredrik
Infectious Diseases Research Unit, Department of Clinical Sciences, Malmö, Lund University, Rut Lundskogs gata 3, plan 6, 20502, Malmö, Sweden.
IHE, The Swedish Institute for Health Economics, PO Box 2127, SE-220 02, Lund, Sweden.
BMC Health Serv Res. 2016 Jul 27;16:311. doi: 10.1186/s12913-016-1565-5.
Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain.
We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative.
According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions.
The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.
抗菌药物管理计划已在医院中广泛推行，以应对日益增加的抗菌药物耐药性。尽管此类计划被普遍使用，但其对抗菌药物耐药性以及社会经济的长期影响尚不确定。
我们对瑞典马尔默市于2013年20周内推行的抗菌药物管理计划进行了成本分析，并与2012年相应的对照期进行比较。计算了两个时期与管理干预相关的所有直接成本和机会成本。将管理期的成本直接与对照期的成本进行比较，并推算出年度成本。进行了两项主要分析，一项仅包括可比直接成本（分析一），另一项包括可比直接成本和机会成本（分析二）。还进行了一项额外分析，包括所有可比直接成本，包括与住院时间相关的成本（分析三），但认为该分析不具代表性。
根据分析一，每年成本为161,990瑞典克朗，分析二则为5,113瑞典克朗。由于该计划导致两个队列在规模和感染严重程度方面存在偏差，并鉴于已证明干预措施不会改变短期患者结局，因此与患者结局相关的成本未纳入分析，我们认为分析二提供了最正确的成本计算。在此分析中，主要成本驱动因素是医生时间和护理时间。分析二的敏感性分析表明，在不同假设下变化相对较小。
在内科引入由传染病专家指导、基于审核的抗菌药物管理计划的年度总成本，包括直接成本和机会成本，经计算低至5,113瑞典克朗。
