Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program

BACKGROUND. An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship. DESIGN. A descriptive cost analysis before, during, and after the program. PATIENTS/SETTING. A large tertiary care teaching medical center. METHODS. Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY. RESULTS. The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $ 2 million increase for the medical center, mostly in the antibacterial category. CONCLUSIONS. The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period. Infect Control Hosp Epidemiol 2012; 33(4): 338-345