Economic Evaluations on Antimicrobial Stewardship Programme: A Systematic Review.

PURPOSE: To systematically review studies on cost-effectiveness of implementing Antimicrobial stewardship programmes (ASP) in the hospital setting. METHODS: A systematic literature search was performed using electronic databases, such as EMBASE, PubMed/Medline, CINAHL, NHS and CEA Registry from 2000 until 2017. The quality of each included study was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Economic Evaluations and Consolidated Health Economic Evaluation Reporting Standards Statement checklist. RESULTS: Of the 313 papers retrieved, five papers were included in this review after assessment for eligibility. The majority of the studies were cost-effectiveness studies, comparing ASP to standard care. Four included economic studies were conducted from the provider (hospital) perspective while the other study was from payer (National Health System) perspective. The cost included for economic analysis were as following: personnel costs, warded cost, medical costs, procedure costs and other costs. CONCLUSIONS: All studies were generally well-conducted with relatively good quality of reporting. Implementing ASP in the hospital setting may be cost-effective. However, comprehensive cost-effectiveness data for ASP remain relatively scant, underlining the need for more prospective clinical and epidemiological studies to incorporate robust economic analyses into clinical decisions. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Evaluation of pharmacy value-added services in public health facilities: Staff perception and cost analysis.

Background: Pharmacy Value Added Services (VAS) were introduced in Malaysian public health facilities to facilitate the process of medicine collection. Examples include Drive-through pharmacy, Medicine by Post, SMS Take&Go, Appointment Card and medicine locker, commonly referred to as Medibox. Objectives: To assess the perception of VAS among pharmacy staff, and to compare the time and cost needed to prepare medications for VAS and conventional counter service. Methods: A cross-sectional study was conducted in 17 public health facilities across Kuala Lumpur and Putrajaya from May until September 2020. There were two parts of this study: 1) a survey on the perception of VAS among pharmacy staff, which assessed respondents' experience of handling VAS and their perception towards the services; and 2) a cost analysis to compare the direct cost of preparing refill medications for VAS and conventional counter service, estimated from average salary and direct non-medical cost. Results: 290 respondents answered the survey. Most respondents had a positive opinion about VAS. Lack of storage and insufficient manpower were the top two barriers in VAS utilisation and implementation as perceived by pharmacy staff. The average time (in minutes) needed to prepare one prescription was highest for Medicine by Post service (10.31), followed by Medibox (10.25), Appointment Systems (6.24) and conventional counter service (3.99). Medibox had the highest average cost per prescription (RM5.49), followed by Medicine by Post (RM5.05), Appointment Systems (RM2.89) and conventional counter service (RM1.75). Conclusions: The majority of the respondents involved in this study acknowledged the benefits of VAS to patients, but there were aspects of the services that could be improved. Preparation of patient medication for VAS requires significantly more time and cost than conventional counter service, indicating the need to review and streamline implementation of the services.