Pharmacoeconomic evaluation of an antimicrobial stewardship program in a tertiary care hospital of Sindh, Pakistan

Abstract

Background & Objective: Escalation of antimicrobial resistance (AMR) globally has led to increased use of healthcare resources, increased lengths of hospital stay, and increased costs of treatment. Our objective was to determine the economic impact of Antimicrobial Stewardship Program (ASP) implementation on antimicrobial therapy cost and its correlation with demographic factors.

Methodology: A prospective, quasi - experimental, pharmacoeconomic study was carried out for an eighteen months period (July 2023 to December 2024) in People’s Medical College Hospital Nawabshah. Three thousand patients were recruited based on Cochran’s formula (1500 in each study phase i.e. pre and post ASP implementation). Analyses were done from hospital perspective, focusing solely on direct costs of antimicrobial treatment. Demographic subgroups were analyzed for their effect on the costs. Statistical procedure included descriptive statistics, independent t tests, chi square tests and multivariate linear regression. A threshold for significance, p<0.05 was considered.

Results: Mean antimicrobial-therapy costs dropped significantly after ASP implementation in both medical and surgical wards, by a total of 17%. In 18-29 aged patients, reduction in cost was seen 16.2% followed by 18% in 30-49 years, 17.1% in 50-69 years and 14.7% in ≥70 years patients. Multivariate regression analysis showed that age, type of ward and gender were independent determinants of cost and the implementation of ASP was the strongest cost reducing predictor identified.

Conclusion: ASP has potential of providing much greater pharmacoeconomic benefits in hospitals. There is significant influence of demographic factors in particular, age and ward type have critical role on costs of antimicrobials.