Health economic studies of antimicrobial stewardship programmes: A scoping review.

Aims: To conduct a scoping review of health economic evaluations of antimicrobial stewardship programmes (ASP). Our purpose was to summarise findings and to review different approaches taken. Methods: We reviewed economic evaluation studies retrieved from a number of sources, assessing the costs and effects of ASP. We described and synthesised data from studies published between 2002 and 2023 that included measures of both costs and effects/benefit of interventions. Results: Eight studies met the inclusion criteria. Six studies estimated cost-effectiveness, and two studies assessed cost utility. We found no cost-benefit studies. One of the studies was based on a randomised controlled trial. None of the studies took a broad perspective to include societal benefits that might arise from less resistant organisms on the environment contingent on reductions of prescriptions of broad-spectrum antibiotics. Conclusion: Limited evidence on the cost-effectiveness of Antimicrobial Stewardship Interventions studies suggests that the implementation of strategies to reduce antimicrobial resistance is worth the investment. However, producing a summary measure of ASP interventions is limited not just by the paucity of studies, but also heterogeneity of intervention types, variation in the implementation contexts and different methodological approaches.