A Return On Investment Evaluation Of An Antibiotic Audit And Feedback Program Among Family Physicians
Author(s)
Lisa Masucci, MSc1, Kevin Schwartz, MD2, Noah Ivers, MD3, Li Bai, PhD4, Kednapa Thavorn, PhD5;
1University of Toronto, Toronto, ON, Canada, 2Ontario Agency for Health Protection and Promotion, Toronto, ON, Canada, 3Women's College Hospital, Toronto, ON, Canada, 4Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, 5The Ottawa Hospital Research Institute, Ottawa, ON, Canada
1University of Toronto, Toronto, ON, Canada, 2Ontario Agency for Health Protection and Promotion, Toronto, ON, Canada, 3Women's College Hospital, Toronto, ON, Canada, 4Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, 5The Ottawa Hospital Research Institute, Ottawa, ON, Canada
Presentation Documents
OBJECTIVES: The misuse of antimicrobials in healthcare is one of the key modifiable drivers of the emergence of antimicrobial resistance. This study aims to determine the return on investment (ROI) of an antibiotic audit and feedback (A&F) program from a Canadian public payer perspective.
METHODS: A pragmatic trial randomized 5,097 physicians 4:1 to receive an antibiotic A&F mailed letter versus no letter in Ontario, Canada in January 2022. A model was developed to calculate the monetary costs and benefits associated with the antibiotic A&F program utilizing costs from antibiotic prescriptions, adverse events, and undertreatment harms. The data were obtained using administrative data at the Institute for Clinical Evaluative Sciences. The ROI was estimated by dividing the incremental costs by the incremental monetary benefits. An ROI >1 indicates that the monetary benefit of the program exceeds the costs, whereas an ROI <1 indicates that the monetary costs exceed benefits. We performed a probabilistic analysis with 5,000 simulations to estimate the mean outcomes. Deterministic one-way sensitivity analyses were conducted to assess the impact of key parameters on the results.
RESULTS: Trial results demonstrated a significant relative reduction in antibiotic prescribing at 6 months of 5% (95%CI; 4%-6%). Total antibiotic cost savings per physician was a mean of $53.36. The antibiotic A&F program resulted in an ROI of 3.92 (95% CI 3.91- 4.64). For every dollar spent on the antibiotic A&F program there was a $3.92 return. The probability of the antibiotic A&F program being a good return on investment (ROI > 1) was 54%. A sensitivity analysis showed that the model results were robust to most changes in the parameter values, but sensitive to the mean difference in costs from undertreatment harms.
CONCLUSIONS: The antibiotic A&F program offers a good return on investment to address the overprescribing of unnecessary antibiotics among family physicians.
METHODS: A pragmatic trial randomized 5,097 physicians 4:1 to receive an antibiotic A&F mailed letter versus no letter in Ontario, Canada in January 2022. A model was developed to calculate the monetary costs and benefits associated with the antibiotic A&F program utilizing costs from antibiotic prescriptions, adverse events, and undertreatment harms. The data were obtained using administrative data at the Institute for Clinical Evaluative Sciences. The ROI was estimated by dividing the incremental costs by the incremental monetary benefits. An ROI >1 indicates that the monetary benefit of the program exceeds the costs, whereas an ROI <1 indicates that the monetary costs exceed benefits. We performed a probabilistic analysis with 5,000 simulations to estimate the mean outcomes. Deterministic one-way sensitivity analyses were conducted to assess the impact of key parameters on the results.
RESULTS: Trial results demonstrated a significant relative reduction in antibiotic prescribing at 6 months of 5% (95%CI; 4%-6%). Total antibiotic cost savings per physician was a mean of $53.36. The antibiotic A&F program resulted in an ROI of 3.92 (95% CI 3.91- 4.64). For every dollar spent on the antibiotic A&F program there was a $3.92 return. The probability of the antibiotic A&F program being a good return on investment (ROI > 1) was 54%. A sensitivity analysis showed that the model results were robust to most changes in the parameter values, but sensitive to the mean difference in costs from undertreatment harms.
CONCLUSIONS: The antibiotic A&F program offers a good return on investment to address the overprescribing of unnecessary antibiotics among family physicians.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE484
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas