Department of Economics, University of Utah, Salt Lake City, Utah.
Department of Pharmacy Practice and Administrative Sciences, Idaho State University College of Pharmacy, Meridian, Idaho.
Infect Control Hosp Epidemiol. 2022 Oct;43(10):1389-1395. doi: 10.1017/ice.2021.393. Epub 2021 Sep 29.
The 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.
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.
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.
Implementation of the CDC Core Elements in the outpatient setting was a cost-effective strategy.
该框架旨在改善抗生素的使用，但有关实施门诊抗生素管理干预措施的成本效益数据有限。我们评估了在门诊环境中实施核心要素的成本效益。
从卫生系统的角度出发，为患有单纯性急性呼吸道感染（ARI）的门诊患者开发了一种经济模拟模型。使用质量调整生命年（QALY）来衡量有效性。抗生素治疗、药物不良反应（ADE）和医疗保健利用的成本和效用参数均来自文献。抗生素治疗和适当性、ADE、住院和复发性 ARI 就诊的概率是根据干预和对照地点在实施前后的 16712 次和 51275 次就诊中估计得出的。用于执行管理活动的材料和劳动力的数据用于估算干预成本。我们使用 1000000 个二级蒙特卡罗模拟对输入参数进行了单向和概率敏感性分析（PSA）。
与对照点相比，实施后干预点开具抗生素的 ARI 患者就诊比例较低（62%比 74%），适当治疗比例较高（51%比 41%）。在 2 年内，干预措施的估计成本为 133604 美元（2018 年美元）。与常规护理相比，干预组的平均成本（528 美元比 565 美元）和平均 QALY（0.869 比 0.868）均较低。在 PSA 中，干预在 63%的迭代中占主导地位。
在门诊环境中实施 CDC 核心要素是一种具有成本效益的策略。
