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Sustained Savings from a Longitudinal Cost Analysis of an Internet-Based Preapproval Antimicrobial Stewardship Program

Published online by Cambridge University Press:  02 January 2015

Anna C. Sick ,
Christoph U. Lehmann ,
Pranita D. Tamma ,
Carlton K. K. Lee  and
Allison L. Agwu
Anna C. Sick
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Christoph U. Lehmann
Affiliation:
Departments of Pediatrics and Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
Pranita D. Tamma
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Carlton K. K. Lee
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland
Allison L. Agwu*
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Department of Pediatrics, Division of Pediatric Infectious Diseases, and Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Room 3145, Baltimore, MD 21287 (ageorg10@jhmi.edu).
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Abstract

Objective.

To evaluate an internet-based preapproval antimicrobial stewardship program for sustained reduction in antimicrobial prescribing and resulting cost savings.

Design.

Retrospective cohort study and cost analysis.

Methods.

Review of all doses and charges of antimicrobials dispensed to patients over 6 years (July 1, 2005–June 30, 2011) at a tertiary care pediatric hospital.

Results.

Restricted antimicrobials account for 26% of total doses but 81% of total antimicrobial charges. Winter months (November–February) and the oncology and infant and toddler units were associated with the highest antimicrobial charges. Five restricted drugs accounted for the majority (54%) of charges but only 6% of doses. With an average approval rate of 91.5% (95% confidence interval [CI], 91.1%–91.9%), the preapproval antibiotic stewardship program saved $103,787 (95% CI, $98,583–$109,172) per year, or $14,156 (95% CI, $13,446–$14,890) per 1,000 patient-days.

Conclusions.

A preapproval antimicrobial stewardship program effectively reduces the number of doses and subsequent charges due to restricted antimicrobials years after implementation. Hospitals with reduced resources for implementing postprescription review may benefit from a preapproval antimicrobial stewardship program. Targeting specific units, drugs, and seasons may optimize preapproval programs for additional cost savings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 6 , June 2013 , pp. 573 - 580
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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