Ruiz-Ramos Jesus, Frasquet Juan, Romá Eva, Poveda-Andres Jose Luis, Salavert-Leti Miguel, Castellanos Alvaro, Ramirez Paula
a Intensive Care Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain.
b Microbiology Department , Hospital Universitario y Politecnico La Fe , Valencia , Spain.
J Med Econ. 2017 Jun;20(6):652-659. doi: 10.1080/13696998.2017.1311903. Epub 2017 Apr 13.
To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting.
A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses.
In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG.
Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided.
Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.
基于西班牙的情况假设，评估以重症监护病房为重点实施抗菌药物管理（AS）计划的成本效益。
设计了一个决策模型，比较有或没有AS的重症监护病房中败血症、社区获得性肺炎和医院感染（包括导管相关菌血症、尿路感染和呼吸机相关性肺炎）的成本和结果。模型变量和成本及其分布来自文献。该研究从西班牙国家卫生系统（NHS）的角度进行，仅包括直接成本。分析了增量成本效益比（ICER）与该计划减少多重耐药菌的能力。通过概率敏感性分析评估ICER的不确定性。
在短期内，实施AS可减少抗菌药物的消耗，净收益为71,738欧元。从长期来看，维持该计划会给系统带来额外成本107,569欧元。每避免一次耐药的成本为7,342欧元，每获得一个生命年（LYG）的成本为9,788欧元。概率敏感性分析结果表明，AS在每LYG 8,000欧元的水平上具有成本效益的可能性超过90%。
实施这类AS计划所获得的经济结果差异很大，且关于其对患者病情发展和避免的任何耐药性影响的信息较少。
针对重症监护患者实施AS是一种长期具有成本效益的工具。实施成本可通过减少抗菌药物消耗以预防多重耐药病原体感染来摊销。
