Cost effectiveness of antibacterial restriction strategies in a tertiary care university teaching hospital

Objective: To compare various strategies for antibacterial administration i n terms of patient outcomes, overall costs and quality of care provided. Design: Prospective, nonblind, randomized, clinical study. Setting: Tertiary care hospital in Greece from November 1995 to June 1996. Patients and participants: 458 patients admitted to the internal medicine d epartment who received antibacterial therapy for infectious diseases. Methods: Patients were randomized into 4 different antibacterial administra tion policies defined by various levels of restriction control. Efficacy an d resource use data were obtained from clinical study case report forms, th e hospital financial database and physician expert opinion. Outcomes includ ed complete infection control, disease improvement, unchanged patient condi tion, infection needing surgical treatment, and death. Direct medical costs were estimated. The perspective adopted was that of the healthcare system (hospital budget; third-party payor). Cost-minimisation analysis was based on cost per patient treated. Results: 382 eligible patient records examined showed no significant differ ence in clinical outcomes among patient groups. Baseline analysis showed th e strict antibacterial control policy to produce statistically significant differences (p < 0.05) in various resource parameters. Accordingly, compare d with all other patient groups, total cost per patient for that strategy w as reduced by 26 to 30%. Also, patients in that group received fewer drug d oses and underwent fewer treatment days, and antibacterial treatment was mo dified in fewer cases for these patients. Conclusion: Strict control of antibacterial administration in this hospital setting achieved lower direct medical costs with no harmful effect on pati ent outcomes or quality of care provided. Such a policy appears to be a use ful option for both physicians and administrators.