Economic evaluations of antibiotic stewardship programmes 2015-2024: a systematic review

Background: Numerous studies have demonstrated the effectiveness of Antibiotic Stewardship Programmes in reducing antibiotic resistance and healthcare costs. However, the use of different methods to assess these costs, along with the uncertainty regarding which interventions are cost-effective, hampers the comparison of results and the formulation of clear recommendations. The aim of this systematic review was to provide a comprehensive overview of the available evidence on economic evaluations of Antibiotic Stewardship Programmes and to assess their impact on healthcare costs. Methods: The systematic review analysed articles indexed in Medline, Embase, Cochrane Reviews and Trials, Business Source Premier or EconLit that assessed the attributed economic impact of Antibiotic Stewardship Programme interventions in acute care settings and were published between 2015 and 2024. Studies identifying as economic analyses, cost-benefit analyses, cost-effectiveness analyses, cost-consequence analyses, cost analyses or cost-minimisation analyses and that fulfilled the essential parameters required for an economic analysis were included. A descriptive analysis was conducted to examine the impact of the interventions on overall costs, length of stay and antimicrobial costs. We also analysed the different kinds of interventions and the type of costs considered in the analyses. Study quality was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, version 2022. Results: A total of 2965 publications were identified, of which 411 underwent full-text screening. The 27 studies ultimately included involved 20,232 patients in total and consistently demonstrated savings in antibiotic costs ranging from 2% to 95% relative cost savings, in length of stay costs (3% to 85%) and in overall hospital costs (3% to 86%). The intervention most frequently implemented was "therapy evaluation, review and/or feedback" (23/27, 85%), followed by "alteration of therapy guidelines" (8/27, 30%) and "education" (6/27, 22%). While operational costs were reported by all studies, implementation costs (8/27, 30%) and societal costs (3/27, 11%) were less frequently analysed. By CHEERS category, 9 (33%) of the included studies were rated as low-quality (<60%), 16 (59%) as medium-quality (60-80%) and 2 (7%) as high-quality (>80%). Conclusions: Our results emphasise that Antibiotic Stewardship Programmes may contribute to a substantial reduction in healthcare costs for a hospital. While the economic reporting in the field has recently improved, certain cost categories should be accounted for more consistently. There remains considerable potential for further improvement and standardisation to enhance the comparability of studies and facilitate the implementation of effective Antibiotic Stewardship Programmes.