Cost-benefit analysis of antimicrobial stewardship program in a cancer setting in Qatar

Background

It is estimated that physicians prescribe antibiotics inappropriately in 50% of cases.1,2 We aimed to compare the economic advantage of mature antimicrobial stewardship program (ASP) versus premature ASP use in hematology and oncology settings in Qatar.

Methods

We investigated the economic benefits of a premature versus a mature ASP from the perspective of a hospital. Premature ASP was defined as the 12 months following the establishment of the ASP (May 2015-April 2016), while mature ASP was the most recent 12 months of ASP implementation at the National Center for Cancer Care and Research (NCCCR) (February 2019-January 2020). Patient records were retrospectively reviewed. The total economic benefit of the ASP maturity was calculated as the sum of the cost savings and the cost avoidance associated with the service minus the operational cost.3 Cost savings were the reduction in therapy cost linked to decreased antimicrobial consumption and resource utilization. Cost avoidance was the expenses saved due to decreased hospital stays and fewer adverse drug events (ADEs). Calculating the cost of an ADE involved assuming an additional 1- 2 days of hospital stay due to the ADE, based on a prior study (unpublished). The operational cost encompassed the time spent in ASP service.

Results

The benefit-to-cost ratio was 640, representing a benefit of 1,017 QAR generated for each 1 QAR invested in the ASP service. ASP maturity led to a substantial reduction in antimicrobial consumption and resource utilization by 1,248,666 QAR Mature ASP had lower avoidance cost, yielding a cost saving of QAR11,969,651. ASP maturity yielded a net benefit of 13,230,794 QAR. Mature ASP had lower operational costs, resulting in cost saving of 12,477 QAR (Figures 1-2).

Conclusions

The observed reductions in antimicrobials costs from reduced antimicrobial use and the added value of cost avoidance signify the positive impact of a well-established ASP.