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A Veterans’ Healthcare Administration (VHA) antibiotic stewardship intervention to improve outpatient antibiotic use for acute respiratory infections: A cost-effectiveness analysis

Published online by Cambridge University Press:  29 September 2021

Minkyoung Yoo Open the ORCID record for Minkyoung Yoo [Opens in a new window] ,
Karl Madaras-Kelly ,
McKenna Nevers ,
Katherine E. Fleming-Dutra ,
Adam L. Hersh ,
Jian Ying ,
Ben Haaland ,
Matthew Samore  and
Richard E. Nelson
Minkyoung Yoo*
Affiliation:
Department of Economics, University of Utah, Salt Lake City, Utah
Karl Madaras-Kelly
Affiliation:
Department of Pharmacy Practice and Administrative Sciences, Idaho State University College of Pharmacy, Meridian, Idaho Pharmacy Service, Boise VA Medical Center, Boise, Idaho
McKenna Nevers
Affiliation:
Informatics Decision Enhancement and Surveillance (IDEAS) Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Katherine E. Fleming-Dutra
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Adam L. Hersh
Affiliation:
Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
Jian Ying
Affiliation:
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
Ben Haaland
Affiliation:
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
Matthew Samore
Affiliation:
Informatics Decision Enhancement and Surveillance (IDEAS) Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Richard E. Nelson
Affiliation:
Informatics Decision Enhancement and Surveillance (IDEAS) Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
*
Author for correspondence: Minkyoung Yoo, E-mail: minkyoung.yoo@utah.edu
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Abstract

Objectives:

The Core Elements of Outpatient Antibiotic Stewardship provides a framework to improve antibiotic use, but cost-effectiveness data on implementation of outpatient antibiotic stewardship interventions are limited. We evaluated the cost-effectiveness of Core Element implementation in the outpatient setting.

Methods:

An economic simulation model from the health-system perspective was developed for patients presenting to outpatient settings with uncomplicated acute respiratory tract infections (ARI). Effectiveness was measured as quality-adjusted life years (QALYs). Cost and utility parameters for antibiotic treatment, adverse drug events (ADEs), and healthcare utilization were obtained from the literature. Probabilities for antibiotic treatment and appropriateness, ADEs, hospitalization, and return ARI visits were estimated from 16,712 and 51,275 patient visits in intervention and control sites during the pre- and post-implementation periods, respectively. Data for materials and labor to perform the stewardship activities were used to estimate intervention cost. We performed a one-way and probabilistic sensitivity analysis (PSA) using 1,000,000 second-order Monte Carlo simulations on input parameters.

Results:

The proportion of ARI patient-visits with antibiotics prescribed in intervention sites was lower (62% vs 74%) and appropriate treatment higher (51% vs 41%) after implementation, compared to control sites. The estimated intervention cost over a 2-year period was $133,604 (2018 US dollars). The intervention had lower mean costs ($528 vs $565) and similar mean QALYs (0.869 vs 0.868) per patient compared to usual care. In the PSA, the intervention was dominant in 63% of iterations.

Conclusions:

Implementation of the CDC Core Elements in the outpatient setting was a cost-effective strategy.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 10 , October 2022 , pp. 1389 - 1395
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: This article was previously presented as Yoo M, Nelson R, Nevers M, et al. VA antibiotic stewardship intervention to improve outpatient antibiotic use for ARIs: a cost-effectiveness analysis. Infect Control Hosp Epidemiol 2020;41 suppl 1:S55.

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