Economic Evaluation of Team-based Antimicrobial Stewardship Programs: A Systematic Review

Antimicrobial resistance is a growing global health threat, contributing to substantial mortality and economic burden. Antimicrobial stewardship programs (ASPs) improve antibiotic use, yet evidence on the cost-effectiveness of multidisciplinary, team-based ASPs remains limited. This study systematically reviewed economic evaluations of team-based ASPs to inform sustainable implementation. A comprehensive search of PubMed, Ovid MEDLINE, EMBASE, and the Cochrane Library identified studies published up to May 2025. Nine full economic evaluations met the inclusion criteria. Across these studies, team-based ASPs consistently improved key clinical outcomes, including increased appropriateness of therapy, reductions in unnecessary prescriptions, improved survival, and gains in quality-adjusted life years. Economic outcomes similarly favored ASP interventions, showing reductions in treatment, antibiotic, and human resource costs. All reported Incremental Cost-Effectiveness Ratios and Incremental Cost-Utility Ratios fell within commonly accepted willingness-to-pay thresholds, and two interventions were dominant, providing better outcomes at lower cost compared with usual care. Overall, team-based ASPs were associated with favorable clinical and economic outcomes, supporting their broader adoption—particularly in high-consumption settings such as Korea.