Hospitals concerned about controlling costs can reduce drug expenditures, improve quality measures and enhance patient safety by implementing an effective antimicrobial stewardship program (ASP). Ensuring that patients receive the appropriate medication for an infection can save money by minimizing the use of unnecessary drugs, reducing the incidence of Clostridium difficile in patients and slowing the emergence of difficult and expensive to treat antibiotic resistant organisms. How much difference can an ASP make?
The savings in direct costs could be substantial:
Duplicative therapies: Reducing the use of duplicative therapies, particularly those used to treat anaerobic infections, could save U.S. hospitals $163 million. A study in Infection Control and Hospital Epidemiology looked at inpatient pharmacy data from more than 500 hospitals over a three year period and found that 78% of hospitals showed administration of potentially unnecessary combinations of antibiotics for two days or longer.1
Other reduced costs: In a recent review of prescription records over a three year period, the Centers for Disease Control and Prevention (CDC) found that 30% to 50% of inpatient antibiotic prescriptions continue to be inappropriate or incorrect.2 An ASP can reduce those rates and their associated costs. At one 583 bed hospital, implementation of an ASP reduced antimicrobial expenditures by 9.75% in the first year, following an average yearly increase of 14.4% for the several years prior. The hospital saved $1.7 million with no significant differences in survival, length of stay or readmissions for two studied illnesses.3
As substantial as the direct costs of prescribing the wrong medication are, the hidden costs can be greater:
Clostridium difficile infections: The CDC estimates that patients exposed to broad-spectrum antibiotics during hospitalization have three times the risk of developing a C. difficile infection (CDI) compared to patients not treated with antibiotics. Reducing the use of the broad-spectrum antibiotics would cut CDI rates by 26%. These infections cost U.S. acute care hospitals $4.8 billion a year.4
Adverse drug events: Restricting antibiotic use would also reduce adverse drug events among hospitalized patients, as they are among the most common causes of ADEs, according to the CDC.
Multidrug resistant organisms (MDROs): Inappropriate use of antibiotics promotes the emergence of resistant organisms which are more difficult and expensive to treat. An estimated $34 billion per year in inpatient costs associated with MDROs is attributed to the inappropriate or unnecessary use of antibiotics in hospitals.5 MDROs do not simply increase the cost of treatment; for a growing number, few or no effective treatments remain--at any price.
Does your hospital track costs of antimicrobial use?
- Schultz L, Lowe TJ, Srinivasan A, Neilson D, Pugliese G. Economic impact of redundant antimicrobial therapy in US hospitals. Infect Control Hosp Epidemiol. 2014 Oct;35(10):1229-35.
- Fridkin S, Baggs J, Fagan R, et al. Vital Signs: Improving Antibiotic Use Among Hospitalized Patients. MMWR. March 7, 2014; 63(09):194-200.
- Nowak MA, Nelson RE, Breidenbach JL, Thompson PA, Carson PJ. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health-Sys Pharm. Sept 1, 2012;69:1500-07.
- Dubberke ER, Olsen MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis. 2012 Aug; 55 Suppl 2:S88-92.
- IMS Institute for Healthcare Informatics. Avoidable Costs in U.S. Healthcare: The $200 Billion Opportunity from Using Medicines More Responsibly. June 2013.