さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

Is Antimicrobial Stewardship Cost-Effective? A Narrative Review of the Evidence.

2017年 6月 CMI に発表された、ASPと費用効果に関するReview

 

www.ncbi.nlm.nih.gov

 

 

 Abstract

 

AIMS: 

This narrative review aimed to collate recent evidence on the cost-effectiveness and cost-benefit of antimicrobial stewardship(AMS) programmes, to address the question "is AMS cost-effective?", whilst providing resources and guidance for future research in this area.

 

SOURCES: 

PubMed was searched for studies assessing the cost-effectiveness, cost-utility or cost-benefit of AMS interventions in humans, published from January 2000 to March 2017, with no setting inclusion/exclusion criteria specified. Reference lists of retrieved reviews were searched for additional articles.

 

CONTENT: 

Recent evidence on the cost-effectiveness and cost-benefit of AMS is described, studies suggest persuasive and structural AMS interventions may provide health economic benefits to the hospital setting. However overall, cost-effectiveness evidence for AMS is severely limited, especially for the community setting. Recommendations for future research in this area are therefore provided, including discussion of appropriate health economic methodological choice.

 

IMPLICATIONS: 

Health systems have a finite and decreasing resource, decision makers currently do not have necessary evidence to assess whether AMS programmes provide sufficient benefits. While the evidence-base of the cost-effectiveness of AMS is increasing, it remains inadequate for investment decision-making. Robust health economics research needs to be completed to enhance the generalisability and usability of cost-effectiveness results.

 

 

Methods

 

PubMed was searched for literature published from Jan 2000 to March 2017, with the three main types of health economic evaluations used as search terms [14];

 

*1 AND *2, limited to “human”.

 

Title/abstracts and full texts of retrievals were reviewed (See Supplementary Material Table I for inclusion/exclusion criteria).

 

Reference lists of retrieved reviews were searched for additional

 

 

Fig and Tab

 

f:id:akinohanayuki:20170627052417p:plain

f:id:akinohanayuki:20170627052432p:plain

f:id:akinohanayuki:20170627052458p:plain

f:id:akinohanayuki:20170627052506p:plain

f:id:akinohanayuki:20170627052522p:plain

 

感想 

 

ASPに関する費用効果は、まだまだ未整理ですね。

効果測定の方向性は固まってきましたので、これから妥当性の高い費用報告も増えるのではと期待してます。

Fig1は勉強になります。

 

私は、費用効果の難しさは、費用がなまものであることだと思います。

費用の価値は、時代、国、個人によっても異なり変化(株価や為替のように)しています。よって、数年期間をかけた研究の妥当性をどのように解釈するのか難しいです。

 

 

*1:cost-effectiveness) OR (cost-benefit) OR (cost-utility) OR (cost effectiveness) OR (cost benefit) OR (cost utility

*2:antimicrobial stewardship) OR (antibiotic stewardship