Assessing the social cost and benefits of a national requirement establishing antibiotic stewardship programs to prevent Clostridioides difficile infection in US hospitals

• Type of Material: Article
• Authors: R. Douglas Scott II, Centers for Disease Control and Prevention; Rachel B. Slayton, Centers for Disease Control and Prevention; Fernanda C. Lessa, Centers for Disease Control and Prevention; James Baggs, Centers for Disease Control and Prevention; Steven D Culler, Emory University; L. Clifford McDonald, Centers for Disease Control and Prevention; John A. Jernigan, Centers for Disease Control and Prevention
• Language: English
• Date: 2019-01-22
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s). 2019
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13756-018-0459-1
• Title of Journal or Parent Work: Antimicrobial Resistance and Infection Control
• ISSN: 2047-2994
• Volume: 8
• Start Page: 17
• End Page: 17
• Grant/Funding Information: Not applicable.
• Keywords: FINANCIAL IMPACT; POPULATION; IMPLEMENTATION; EPIDEMIOLOGY; Regulatory impact analysis; MORTALITY RISK REDUCTIONS; Microbiology; Cost-benefit analysis; Public, Environmental & Occupational Health; Antibiotic stewardship; Value of statistical life; METAANALYSIS; Infectious Diseases; Healthcare-associated infections; Life Sciences & Biomedicine; LIFE; Science & Technology; ECONOMIC OUTCOMES; DISEASE; Clostridioides difficile infection; ANTIMICROBIAL STEWARDSHIP
• Research Categories: Biology, Microbiology; Health Sciences, Public Health

Abstract

Backgound: Economic evaluations of interventions to prevent healthcare-associated infections in the United States rarely take the societal perspective and thus ignore the potential benefits of morbidity and mortality risk reductions. Using new Department of Health and Human Services guidelines for regulatory impact analysis, we developed a cost-benefit analyses of a national multifaceted, in-hospital Clostridioides difficile infection prevention program (including staffing an antibiotic stewardship program) that incorporated value of statistical life estimates to obtain economic values associated with morbidity and mortality risk reductions. Methods: We used a net present value model to assess costs and benefits associated with antibiotic stewardship programs. Model inputs included treatment costs, intervention costs, healthcare-associated Clostridioides difficile infection cases, attributable deaths, and the value of statistical life which was used to estimate the economic value of morbidity and mortality risk reductions. Results: From 2015 to 2020, total net benefits of the intervention to the healthcare system range from $300 million to $7.6 billion when values for morbidity and mortality risk reductions are ignored. Including these values, the net social benefits of the intervention range from $21 billion to $624 billion with the annualized net benefit of $25.5 billion under our most likely outcome scenario. Conclusions: Incorporating the economic value of morbidity and mortality risk reductions in economic evaluations of healthcare-associated infections will significantly increase the benefits resulting from prevention.