Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infections: a probabilistic analysis

J Antimicrob Chemother. 2009 Apr;63(4):816-25. doi: 10.1093/jac/dkp004. Epub 2009 Feb 6.


Objectives: We sought to determine the cost-effectiveness of Antimicrobial Stewardship Teams (ASTs) on the reduction of morbidity and mortality associated with nosocomial bacteraemia.

Methods: A decision analytic model compared costs and outcomes of bacteraemic patients receiving standard treatment with or without an AST consult. Patients with a bacteraemic event during their hospital admission were included in the model. Effectiveness was estimated as quality-adjusted life years (QALYs) over the lifetime of patients. Model variables and costs, along with their distributions, were obtained from the literature and expert opinion. Incremental cost-effectiveness ratios (ICERs) were calculated to estimate the cost per QALY gained from the hospital perspective. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. The cost-effectiveness of clinical decision support systems was evaluated as a secondary analysis.

Results: Implementing an AST for bacteraemia review cost $39,737 (95% CI $27,272-53, 017) and standard treatment cost $39,563 (95% CI $27,164-52,797). The difference in effectiveness between the two strategies was 0.08 QALYs, and the base case ICER from the probabilistic analysis was $2367 per QALY gained [95% CI dominant (less costly, more effective) to $24,379]. Results from the probabilistic sensitivity analysis demonstrated there was more than a 90% likelihood that an AST would be cost-effective at a level of $10,000 per QALY.

Conclusions: Maintaining an AST to improve care for bacteraemia is cost-effective from the hospital perspective. The estimate of $2367 per QALY gained for the AST intervention compares favourably with many currently funded healthcare interventions and services.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / economics*
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / drug therapy*
  • Bacteremia / economics*
  • Bacteremia / epidemiology
  • Bacteremia / mortality
  • Cost-Benefit Analysis
  • Drug Utilization / economics*
  • Humans
  • Referral and Consultation / economics*
  • Treatment Outcome


  • Anti-Bacterial Agents