ArticleBMJ open2021
Cost-utility analysis of antimicrobial stewardship programme at a tertiary teaching hospital in Ethiopia.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- Health economic studies of antimicrobial stewardship programmes: A scoping review.NIHR open research · 2024Pooled it
- Characteristics and Quality Appraisal of the Economic Evaluations Done in Ethiopia: A Systematic Review.PharmacoEconomics - open · 2023Pooled it
- Cost-benefit analysis of pharmacist early active consultation in patients with multidrug-resistant bacteria in China.International journal of clinical pharmacy · 2025Article
- Implementing a healthcare-associated bloodstream infection surveillance network in India: a mixed-methods study on the best practices, challenges and opportunities, 2022.Antimicrobial resistance and infection control · 2024Article
- Antimicrobial Use-Related Problems Among Hospitalized Pediatric Patients: A Prospective Observational Study.Infection and drug resistance · 2024Article
- Evaluation of interventions led by pharmacists in antimicrobial stewardship programs in low- and middle-income countries: a systematic literature review.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Review
- Antimicrobial stewardship: from theory to reality in a resource-limited setting (and beyond).Frontiers in antibiotics · 2024Article
- Antimicrobial resistance control activities at a tertiary hospital in a low-resource setting: an example of Queen Elizabeth Central Hospital in Malawi.Frontiers in antibiotics · 2023Article
- Perceptions of and Preparedness for the Application of Pharmacoeconomics in Practice, among Final Year Bachelor of Pharmacy Students in South Africa: A National Cross-Sectional Study.Pharmacy (Basel, Switzerland) · 2023Article
- A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital.PLOS global public health · 2023Article
- A qualitative study of barriers to antimicrobial stewardship in Indonesian hospitals: governance, competing interests, cost, and structural vulnerability.Antimicrobial resistance and infection control · 2022Article
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveAntimicrobial stewardship (AMS) significantly reduces inappropriate antibiotic use and improves patient outcomes. In low-resource settings, AMS implementation may require concurrent strengthening of clinical microbiology capacity therefore additional investments. We assessed the cost-effectiveness of implementing AMS at Tikur Anbessa Specialised Hospital (TASH), a tertiary care hospital in Ethiopia.
designWe developed a Markov cohort model to assess the cost-utility of pharmacist-led AMS with concurrent strengthening of laboratory capacity compared with usual care from a 'restricted societal' perspective. We used a lifetime time horizon and discounted health outcomes and cost at 3% annually. Data were extracted from a prospective study of bloodstream infections among patients hospitalised at TASH, supplemented by published literature. We assessed parameter uncertainty using deterministic and probabilistic sensitivity analyses.
settingTertiary care hospital in Ethiopia, with 800 beds and serves over half a million patients per year. POPULATION: Cohort of adults and children inpatient population aged 19.8 years at baseline.
interventionLaboratory-supported pharmacist-led AMS compared with usual care. Usual care is defined as empirical initiation of antibiotic therapy in the absence of strong laboratory and AMS. OUTCOME MEASURES: Expected life-years, quality-adjusted life-years (QALYs), costs (US$2018) and incremental cost-effectiveness ratio.
resultsLaboratory-supported AMS strategy dominated usual care, that is, AMS was associated with an expected incremental gain of 38.8 QALYs at lower expected cost (incremental cost savings:US$82 370) per 1000 patients compared with usual care. Findings were sensitive to medication cost, infection-associated mortality and AMS-associated mortality reduction. Probabilistic sensitivity analysis demonstrated that AMS programme was likely to be cost-effective at 100% of the simulation compared with usual care at 1%-51% of gross domestic product/capita.
conclusionOur study indicates that laboratory-supported pharmacist-led AMS can result in improved health outcomes and substantial healthcare cost savings, demonstrating its economic advantage in a tertiary care hospital despite greater upfront investments in a low-resource setting.
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