Financial model based on a successful implementation of a day-2 intervention by a multidisciplinary Antimicrobial Stewardship-Team on a urology ward

Dik, JH., Hendrix, R., Friedrich, AW., Luttjeboer, J., Lo-Ten-Foe, J. R., Wilting, K. R., Nannan Panday, P., Postma, MJ. & Sinha, B., 26-Apr-2015.

Research output: Contribution to conferencePosterAcademic

For more than two years, an Antimicrobial Stewardship-Team (A-Team) is acting successfully at the University Medical Center Groningen, a large academic hospital in the Netherlands. The team performs face-to-face case-audits based on an automatically triggered day-2 bundle. Performance on a urology ward was evaluated with a historically controlled study-cohort. Among others, length of stay (LOS) and nursing time were significantly reduced for a subset of patients. Using this data and combining this with an extensive financial evaluation, should make it possible to construct a financial model for this specific intervention. This model can be used to predict the cost-effectiveness for other wards in the hospital, but also for other hospitals that want to implement a similar program.

The A-Team performed case-audits on day 2, which were triggered by an automatic email from the hospitals clinical pharmacy department, after 48 hours of antibiotic treatment. Treatment was discussed with the attending physician and intervention(s) agreed upon. Time needed for the consultations was scored and used for cost calculations. Together with the already evaluated clinical outcome measures a model was constructed. To account for uncertainties, multivariate sensitivity analyses were performed.

Until now, 1 year of data, consisting of 114 patients was clinically and financially evaluated. LOS and nursing time was reduced for the group of patients with an infection-related DRG and results were published. An A-Team consultation took on average, 12.1 minutes (95% CI: 11.33-12.87), costing in total €80.26. Costs of the outcome measures were calculated to be €716 for one hospital day and an average reduction of 18.1% on the baseline LOS (p=0.012) and €32.42 per day for nursing time on IV medication and an average reduction of 29.2% (p=0.016). Sensitivity analyses show that the price for a hospital day has the most influence on the outcome of the model. A probabilistic sensitivity analysis gave a 95% probability of an outcome between €380 and €1580 reduction in costs per patient. For our academic center, the model predicts the biggest results for the internal medicine ward.

The implementation of a day-2 case-audit was already clinically successful. Now, we show conclusively that it is also highly cost-effective for this urology ward. With this model, the future implementation within a hospital can not only be clinically corroborated but also financially, with the use of already available data from the hospitals data warehouse. Furthermore, other institutions can use the model with their own parameters to predict financial effects of a similar program in their own hospital. Especially when funds are not always readily available for antimicrobial stewardship programs, predicted results of this model can provide additional argumentation to convince financial departments and board of directors.
Original languageEnglish
Publication statusPublished - 26-Apr-2015
Event25th European Congress of Clinical Microbiology and Infectious Diseases - Copenhagen, Denmark
Duration: 25-Apr-201528-Apr-2015
Conference number: 25


Conference25th European Congress of Clinical Microbiology and Infectious Diseases
Internet address


25th European Congress of Clinical Microbiology and Infectious Diseases


Copenhagen, Denmark

Event: Conference



ID: 28315696