A cost-benefit analysis alongside a cluster-randomized trial to improve hospital antibiotic use: does the type of measurement and feedback method matter?

Abstract:

Background: The difference in effect on length of hospital stay (LOS) and days of antibiotic therapy (DOT) between three recommended methods to measure and feedback on hospital antibiotic use, when used as the first step of a three-phase stewardship intervention, was assessed in a cluster-randomized trial in Dutch hospitals. A cost-benefit analysis was performed alongside this trial. Methods: 21 Dutch hospitals participated in a cluster-randomized trial to improve hospital antibiotic use (September 2015-May 2017; 20 months). First, three measurement and feedback methods were randomly allocated to the 42 clusters (21 surgical and 21 non-surgical clusters): 1) measurement and feedback on quantity of antibiotic use (DDD, DOT) from past year’s hospital pharmacy data, versus feedback on performance scores from point prevalence studies using either 2) validated or 3) non-validated quality indicators (QIs). Stewardship teams performed the measurements and received a feedback report for both clusters in their hospital. Second, teams were trained in applying a structured approach to stewardship, ie the systematic development of setting-specific stewardship improvement strategies based on the feedback reports. Third, stewardship teams applied this approach in clinical practice. We estimated costs associated with the study intervention to improve hospital antibiotic use, in relation to economic benefits of this intervention, in terms of reductions in LOS and DOT. Based on a model estimation we calculated the benefit-to-cost ratio of one 20-month intervention cycle. Results: Instruction costs were estimated at€ 1,237 per cluster. Local …

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