PRISMA Checklist

The checklist is for a scoping review of the health economic studies of antimicrobial stewardship programmes (ASP). Antimicrobial stewardship programmes aim to promote the careful use of antibiotics. This can be by reducing the amount of antibiotic prescribed; reducing the number of days the antibiotic is taken; or changing the antibiotic to a more suitable one. Another way is changing how the antibiotic is taken, from being injected into a vein to being taken as a pill. Antimicrobial stewardship interventions have the potential to reduce death and long-term illness by improving antibiotic selection; and to decrease the likelihood of organisms developing resistance to antibiotics. Ideally, health economic analysis should consider the effects of improved antibiotic stewardship on both the individual patient and the benefit to the wider population from less resistant bacteria in the environment. However, measuring the potential benefits of a reduction in resistant bacteria is difficult because any changes observed from a single ASP are small, relative to all the other factors at play. Our scoping review aimed to provide updated evidence for future antimicrobial stewardship programmes. We found six cost-effectiveness studies and two cost-utility studies. The studies use different methods for the economic analysis and collected data from different sources. The studies were also based around different clinical settings, had different types of intervention types and were undertaken in different types of institution in different countries. The vast differences in the studies included in the review suggest a strong argument for the standardisation of methods in terms of outcomes and cost measures.