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Antimicrobial stewardship oversights impact cost-effectiveness
The top 1% of inpatients at a single institution who were administered antimicrobials accounted for almost 50% of expenditures, according to recent findings published in Infection Control and Hospital Epidemiology.
“Multidrug-resistant infections are associated with high morbidity and mortality, often requiring prolonged hospitalization and high-cost medications,” Jennifer Dela-Pena, PharmD, from the department of pharmacy at the University of Wisconsin School of Medicine and Public Health, and colleagues said. “These patients can represent a large fraction of the overall budget, and they reduce cost-control efforts of the [antimicrobial stewardship program (ASP)] team on other patients.”
Dela-Pena and colleagues aimed to characterize the top 1% of inpatients who contributed to the 6-month antimicrobial budget in a tertiary, academic medical center. Further, in this retrospective cohort study, they also sought to identify opportunities that can improve antimicrobial use while curbing expenditures.
The researchers used a pharmacy billing database to identify the top 1% of patients in the antimicrobial budget from July 1 to Dec. 31, 2014, with baseline characteristics collected through a retrospective medical chart review. Patients were presented to the ASP team — comprising two ID physicians and a pharmacist — to determine the appropriate use of high-cost antimicrobials and potential interventions. The researchers defined appropriate use of antimicrobials as therapy that was “effective, safe, and most cost-effective compared with alternative agents.”
They found that out of 10,460 patients who received antimicrobials in 6 months, 106 patients accounted for $889,543 (47.2%) of the antimicrobial budget with a cost per day of $219 + $192 and a cost per admission of $4,733 + $7,614. The researchers observed cost-effective opportunities (n = 71), such as dose optimization, de-escalation, dosage form conversion and improvement in transitions of care in 57 (54%) of 106 patients.
The most commonly prescribed antimicrobials for treatment were daptomycin, micafungin, liposomal amphotericin B and meropenem; with posaconazole and valganciclovir accounting for most of the prophylactic therapy. Immunocompromised patients accounted for 75% of participants, and the ID consult service followed 80% of patients, according to the study.
“Prolonged hospitalization was an important factor influencing antimicrobial cost, especially in patients who required prophylactic therapy owing to immunosuppression,” Dela-Pena and colleagues wrote. “Antimicrobial stewardship programs are responsible for oversight of antimicrobial utilization and responsible for providing cost-effective care … there remain opportunities for improving the cost-effectiveness of antimicrobial therapy.” – by Savannah Demko
Disclosure: The researchers report no relevant financial disclosures.