Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-year Program

Infect Control Hosp Epidemiol. 2012 Apr;33(4):338-45. doi: 10.1086/664909.


Background: An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.

Design: A descriptive cost analysis before, during, and after the program.

Patients/setting: A large tertiary care teaching medical center.

Methods: Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.

Results: The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.

Conclusions: The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Academic Medical Centers / economics*
  • Academic Medical Centers / organization & administration
  • Anti-Infective Agents / administration & dosage
  • Anti-Infective Agents / economics*
  • Anti-Infective Agents / therapeutic use
  • Costs and Cost Analysis
  • Drug Costs*
  • Drug Utilization Review*
  • Humans
  • Maryland
  • Practice Guidelines as Topic
  • Quality Indicators, Health Care


  • Anti-Infective Agents