Current status and challenges of health economic evaluations related to antimicrobial stewardship in Japan: A scoping review up to 2023.

Abstract

Background: Antimicrobial resistance is a major global threat, and the promotion of antimicrobial stewardship (AS) is critical. Although AS is recognized for its economic benefits, the situation in Japan has not yet been thoroughly summarized. This scoping review summarizes the current landscape of health economic evaluations related to AS in Japan, considering challenges and prospects for the future.

Methods: Articles related to AS and economic evaluations were extracted from PubMed, Scopus, and Ichushi-Web using search formulas. After performing primary screening based on titles and abstracts, secondary screening of full texts was conducted to identify suitable studies.

Results: This review identified 41 single-institution studies, primarily from special functioning hospitals, regional medical care support hospitals, and hospitals with more than 500 beds. The most frequently reported AS activities were prospective audits and feedback (48.8%, 20 of 41 articles). Among the economic evaluations, 39 articles demonstrated reductions in drug costs, ranging from 3.74% to 100% for the evaluated drugs. Furthermore, no worsening trends were observed in the outcome measures, including mortality, which was evaluated along with drug and healthcare costs. However, few studies have considered the costs associated with AS operations.

Conclusion: This scoping review indicates that AS may offer economic benefits in terms of drug and healthcare costs in Japan. In the future, promoting research on the economic impact of AS in small- or medium-sized hospitals, along with broader economic evaluations that consider the operational costs of AS, will be necessary to facilitate comparisons with data from other countries.