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Drawing Up a Business Case for an Antimicrobial Stewardship Program

Fundamentally, antimicrobial stewardship programs (ASPs) address urgent needs for optimization of antimicrobials to slow the emergence of resistant pathogens and improve patient outcomes. In the current economic environment, however, these programs often have to prove their value in cost savings. If you need to provide a business case to launch or expand your ASP, the following points may generate positive responses from hospital administrators:1

Actual savings: If you have implemented some aspects of an antimicrobial stewardship program already, demonstrate how they have saved money. These interventions may have been on an individual level that you could project to a larger population or may have been introduced hospital-wide.

Anticipated savings: Published case studies provide estimates of savings generated by ASPs for hospitals of various sizes. Those case studies may guide you in estimating the impact of adoption of specific practices as part of your antimicrobial stewardship program. You may want to break out the expected savings by policy to show the value of building the program over time and also provide the aggregate savings. The impact of some common interventions are fairly easy to determine or estimate. These include:

  • Intravenous to oral conversions: Most ASPs aim to increase the consistency and speed at which patients switch to oral medications from intravenous administration. Oral formulations are typically substantially less expensive. Estimate the savings that would accrue from switching by multiplying the number of days that patients historically could have used oral medications, but didn’t, times the difference between the IV and oral formulation cost.

  • Formulary restrictions and pre-authorization: Interventions that decrease the use of more expensive and broader-spectrum antimicrobials in favor of more cost-effective agents that have similar clinical efficacy significantly reduces pharmacy costs. Review historical records to estimate how often a less expensive antimicrobial could have been used and the cost differential between the prescribed medication and the appropriate substitute.

  • Reduction in therapeutic drug monitoring lab tests: Vancomycin and aminoglycosides, among others, require therapeutic drug monitoring (TDM), but often these labs are requested when they are not needed. Including provider education and dose optimization recommendations as part of the antimicrobial stewardship program can reduce the need for repeat testing. Calculate the savings by estimating the number of likely unnecessary tests (for example, one hospital found that about 60% of its TDM for vancomycin fell in this category) and the cost per test.

  • Lower overall antimicrobial usage: Hospitals that implement ASPs typically reduce their use of antimicrobials 10% to 35%. You may provide a range of savings based on projections of which antimicrobials would be used less and their current cost to your hospital.

  • Improved clinical outcomes: Antimicrobial stewardship programs are also associated with shorter hospital stays, reduced incidence of C. diff. infections, lower rates of antibiotic resistance and fewer adverse events, all of which contribute to cost savings.

1 Antimicrobial Stewardship Toolkit: Best Practices from the GNYHA/UHF Antimicrobial Stewardship Collaborative. 2011.

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