• Cynthia L Gong, Kenneth M Zangwill, Joel W Hay, Daniella Meeker, and Jason N Doctor.
• University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA. gongc@usc.edu.
• J Gen Intern Med. 2019 Jun 1; 34 (6): 846-854.

BackgroundBehavioral economics interventions have been shown to effectively reduce the rates of inappropriate antibiotic prescriptions for acute respiratory infections (ARIs).ObjectiveTo determine the cost-effectiveness of three behavioral economic interventions designed to reduce inappropriate antibiotic prescriptions for ARIs.DesignThirty-year Markov model from the US societal perspective with inputs derived from the literature and CDC surveillance data.SubjectsForty-five-year-old adults with signs and symptoms of ARI presenting to a healthcare provider.Interventions(1) Provider education on guidelines for the appropriate treatment of ARIs; (2) Suggested Alternatives, which utilizes computerized clinical decision support to suggest non-antibiotic treatment choices in lieu of antibiotics; (3) Accountable Justification, which mandates free-text justification into the patient's electronic health record when antibiotics are prescribed; and (4) Peer Comparison, which sends a periodic email to prescribers about his/her rate of inappropriate antibiotic prescribing relative to clinician colleagues.Main MeasuresDiscounted costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios.Key ResultsEach intervention has lower costs but higher QALYs compared to provider education. Total costs for each intervention were $178.21, $173.22, $172.82, and $172.52, and total QALYs were 14.68, 14.73, 14.74, and 14.74 for the control, Suggested Alternatives, Accountable Justification, and Peer Comparison groups, respectively. Results were most sensitive to the quality-of-life of the uninfected state, and the likelihood and costs for antibiotic-associated adverse events.ConclusionsBehavioral economics interventions can be cost-effective strategies for reducing inappropriate antibiotic prescriptions by reducing healthcare resource utilization.

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