Table 1.

Summary on the economic effects of the educational interventions.

Author Year, Country	Antibiotic-Related Measures (Not Cost-Related)	Type of Economic Evaluation	Antibiotics Cost before Intervention or in the CG	Antibiotics Cost after Intervention or in the IG	Cost of the Intervention(s)	Incremental Cost-Effectiveness (Change in Costs)	Interpretation
Aksoy et al., 2021 [45] Turkey	-Reduction in antibiotics prescriptions from 34.94 to 30.25% -Reduction in antibiotics items from 14.14 to 4.12% -Reduction in antibiotics boxes from 12.71 to 6.64%	Cost analysis	-Antibiotics cost before intervention: 11.38%	-Antibiotics cost after intervention: 4.12%	NR	Costs savings of 7.26%	Favor intervention
Armstrong 2001 [46] USA	-Kidney infection: 49% success rate with the antibiotics treatment guideline compared to 42% with no guideline (p = 0.59) -Bladder infection: 72% success rate with the antibiotics treatment guideline compared to 42% with no guideline (p = 0.68)	Cost minimization analysis	Before intervention: Kidney infection event cost: 452 ± USD 1287~452 ± 1287 ppp Bladder infection event cost: 125 ± USD 611~125 ± 611 ppp	After intervention: Kidney infection event cost: 289 ± USD 470~289 ± 470 ppp Bladder infection event cost: 116 ± USD 400~116 ± 400 ppp	NR	-Decrease of 36% in health event costs (p = 0.696) -Decrease of 7% in health event costs (p < 0.05)	Favor intervention
Balcioğlu et al., 2017 [55] Turkey	APR: IG (Algorithm group): n = 23 (0.1%) CG: n = 65 (0.4%)	Cost analysis	Prescription cost in CG: TRY 26.9~19.44 ppp	Prescription cost in IG: TRY 15.4~11.13 ppp	NR	Cost savings of 8.31 ppp	Favor intervention
Butler et al., 2012 [56] UK	-Reduction of 4.2% (95% confidence interval 0.6% to 7.7%) in total oral antibiotic dispensing per 1000 patients -No significant differences in hospital admissions and re-consultation rates between IG and CG	Cost analysis	Antibiotics costs in baseline: CG: GBP 2254.6~3211.68 ppp IG: GBP 2199.7~3133.48 ppp	Antibiotics costs in follow-up CG: GBP 2252.3~3208.40 ppp IG: GBP 2078.9~2961.40 ppp	Total costs of intervention: GBP 96,460~137,407.41 ppp	-Cost savings of GBP 120.8~172.08 ppp in the intervention group -Decrease of 5.5% (−0.4; 11.4, p = 0.07) in antibiotic cost	Favor intervention
Cals et al., 2011 [51] Netherlands	-IG1 (CRP group): 43 ± 39.1 antibiotics at index consultation; 3.35 ± 4.54 days of work; EUR 98 ± 89.1 diary cost -IG2 (Communication skills training group): 28 ± 33.3 antibiotics at index consultation; 3.37 ± 4.02 days of work; EUR 74 ± 88.1 diary cost -IG3 (CRP + communication skills training group): 27 ± 23.1 antibiotics at index consultation; 3.39 ± 4.08 days of work; EUR 110 ± 94 diary cost -CG (Usual care): 80 ± 66.71 antibiotics at index consultation; 3.37 ± 3.77 days of work; EUR 104 ± 86.7 diary cost	Cost effectiveness analysis	NR	NR	Total costs -IG1: EUR 37.58 ± 45.24~117.22 ± 54.11 ppp -IG2: EUR 25.61 ± 44.49~30.63 ± 53.22 ppp -IG3: EUR 37.78 ± 42.08~45.19 ± 50.33 ppp -CG: EUR 35.96 ± 58.12~43.01 ppp	Incremental cost-effectiveness ratio: -IG1: 5.79 -IG2: Dominant -IG3: 4.15	Favor intervention
Chazan et al., 2007 [44] Israel	Seasonal intervention: -change from 27.8 to 23.2 DDD/1000 patients/day in total antibiotics use -NS difference in the narrow-spectrum antibiotics use Continuous intervention: -change from 28.7 to 22.9 DDD/1000 patients/day in total antibiotics use -reduction in broad-spectrum antibiotic use (17.6%)	Cost analysis	NR	NR	NR	-Cost savings of USD 186~186 ppp per 1000/patients/season in the seasonal intervention -Cost savings of USD 330~330 ppp per 1000/patients/season in the continuous intervention	Favor intervention
Coenen et al., 2004 [52] Netherlands	In IG: -APR, pre-test: 43%; post-test: 27.4%; −15.6% of change; -Use of recommended antibiotics, pre-test: 40.1%; post-test: 53.8%; −13.6% of change In CG: -APR, pre-test: 37.8%; post-test: 28.7%; −9.1% of change; -Use of recommended antibiotics, pre-test: 37.5%; post-test: 37.4%; −0.1% of change	Cost analysis	Medication cost in CG, pre-test: EUR 21.48~23.66 ppp post-test: EUR 22.35~24.61 ppp	Medication cost in IG, pre-test: EUR 22.35~24.61 ppp post-test: EUR 16.75~18.75 ppp	NR	Change in medication cost: CG: EUR 0.87~0.96 ppp IG: EUR 6.11~6.73 ppp Mean difference: −6.76 (95% CI: −12.30; −1.89)	Favor intervention
Conklin et al., 2009 [64] Pennsylvania	In kiosk prescribers: First line APR decreased from 49.1 to 47.0%; median decrease of 2.3% (SD, 13.0%)	Cost analysis	In non-kiosk prescribers: Mean antibiotic cost per claim: USD 33.56~33.56 ppp	In kiosk prescribers: Mean antibiotic cost per claim: USD 29.42~29.42 ppp	NR	A median cost decrease of antibiotic per claim of USD 3.56~3.56 ppp	Favor intervention
Dekker et al., 2018 [53] Netherlands	IG: mean antibiotics of 0.25; 4.5 h of work absence; 0.5 h of non-productivity CG: mean antibiotics of 0.50; 3.1 h of work absence; 1.5 h of non-productivity	Cost effectiveness analysis	-Prescribed medication cost per child: EUR 8.81~11.31 ppp -Mean total cost: EUR 207.68 (140–284)~267.28 (18.18; 365.50) ppp	-Prescribed medication cost per child: EUR 4.77~6.14 ppp -Mean total cost: EUR 217.95 (150; 301)~280.50 (193.05; 470.40) ppp	Costs of intervention per child: EUR 2.9~3.73 ppp	Cost savings per child of EUR 4.04~5.20 ppp Mean incremental cost-effectiveness ratio: EUR 0.85~1.09 ppp per percentage decrease in antibiotic prescription	Favor intervention
Farris et al., 1996 [38] USA	1st study period -change in APR: −9.5% -change in amoxicillin ratio: −5.5% 2nd study period -change in APR: −3.2% -change in amoxicillin ratio: −12.1%	Cost analysis	NR	Average cost per prescription: 1st study period, USD 40.54~40.54 ppp 2nd study period, USD 41.08~41.08 ppp	USD 3700~3700 ppp	Cost savings: USD 3784~3784 ppp Net savings: USD 84~84 ppp	Favor intervention
Figueiras et al., 2020 [57] Spain	% of reduction in IG relative to CG: -Reduction of −4.23 (95% CI: −5.26; −3.21) DDD in antibiotics for systemic use; -Reduction of −6.51 (95% CI: −7.92; −5.22) DDD in penicillins; -Reduction of −3.89 (95% CI: −6.18; −1.65) DDD in cephalosporins; -Reduction of −3.45 (95% CI: −5.23; −1.70) DDD in macrolides, lincosamides and streptogramins -Reduction of −0.47 (95% CI: −2.37; 0.93) DDD in quinolones; Reduction of −8.97 (95% CI: −13.99; −4.12) in consumption ratio of broad-to narrow-spectrum antibiotics	Cost analysis	NR	NR	Total cost of intervention: 105. EUR 834~168.79 ppp	Savings in absolute direct costs of −4.33% (95% CI: −5.38; −3.29) Savings in cost per physician of −4.33% (95% CI: −5.38; −3.29) Savings in direct costs per 1000 inhabitants −4.46 (95% CI: −5.54; −3.4)% Total direct cost savings of EUR 697.38 (−861.79; −533.22)~−1112.25 (−1374.47; −850.43) ppp	Favor intervention
Furst et al., 2015 [42] Slovenia	Antibiotics prescriptions decreased 53%	Cost analysis	NR	NR	Cost of the intervention EUR 325,000~591,596.64 ppp + EUR 500,000~840,336.13 ppp	Cost savings in antibiotics of EUR 13.1 million~22.02 million ppp	Favor intervention
Gillespie et al., 2016 [58] Ireland	-IG1 (Arm A): 78.6% antimicrobial prescriptions; EUR 84.2 (SD: 24.6) of cost per consultation; 68.2% first-line antimicrobials -IG2 (Arm B): 75.8% antimicrobial prescriptions; EUR 88.7 (SD: 24.3) of cost per consultation; 66.5% first-line antimicrobials -CG: 66.5% prescriptions; EUR 67 (SD: 26.1) of cost per consultation; 44.1% first-line antimicrobials	Cost effectiveness analysis	Antimicrobial prescriptions cost per consultation in CG: EUR 5.3 (SD: 4.0)~6.68 (SD: 5.04) ppp	Antimicrobial prescriptions cost per consultation: -IG1: EUR 5.1 (SD: 3.4)~6.42 (SD: 4.28) ppp -IG2: EUR 5.2 (SD: 3.5)~6.55 (SD: 4.41) ppp	Cost related to intervention set-up, audit and feedback -IG1: EUR 16.3~20.53 ppp per consultation -IG2: EUR 16.4~20.65 ppp per consultation	ICERs per % increase in first-line antimicrobial prescription for UTI: -IG1: EUR 64.2 (95% CI: 22.0, 121.8)~80.86 (95% CI: 27.71; 153.40) ppp -IG2: EUR 105.4 (95% CI: 46.6, 241.7)~132.75 (95% CI: 58.69; 304.41) ppp	Favor intervention
Gong et al., 2019 [47] USA	-CG: 14.68 QALYs; Intervention cost of 178.21$~178.21 ppp -IG1 (suggested alternatives): 14.73 QALYs; Intervention cost of USD 173.22~173.22 ppp -IG2 (accountable justifications): 14.74 QALYs; Intervention cost of USD 172.82~172.82 ppp -IG3 (peer comparison): 14.74 QALYs; Intervention cost of USD 172.52~172.52 ppp	Cost effectiveness analysis	NR	NR	Cost of implementation-IG1: 1.91 (0–5.73) -IG2 3.82 (0–9.55) -IG3 0.95 (0–3.82)	Overall budget impact: -CG: USD17.82 million~17.82 million ppp -IG1: USD 17.32 million~17.32 million ppp -IG2: USD 17.28 million~17.28 million ppp -IG3: USD 17.25 million~17.25 million ppp	Favor intervention
Hux et al., 1999 [41] Canada	IG: pre, 67.2%; post, 69.8% in first-line antibiotics CG: pre, 68.5%; post, 66.8% in first-line antibiotics (p < 0.001)	Cost analysis	Median antibiotic cost in CG: pre, CAD 10.78~8.77 ppp; post, CAD 14.15~11.52	Median antibiotic cost in IG: pre, CAD 11.50~9.36 ppp; post, CAD 11.55~9.41 ppp	NR	No savings in median antibiotic cost in the IG and an increase in CG cost	Unclear
Lanbeck et al., 2016 [69] Sweden	IG: 7193 days at the hospital; 108 deaths; 180 patients readmitted within 28 days. CG: 7402 days at hospital; 117 deaths; 203 patients readmitted within 28 days.	Cost analysis	Oral antibiotic treatment cost: SEK 94,367~10,695.57 ppp Intravenous antibiotic treatment cost: SEK 690,440~78,254.56 ppp	Oral antibiotic treatment cost: SEK 46,850~5309.99 ppp Intravenous antibiotic treatment cost: SEK 616,264~69,847.44 ppp	Cost of intervention: SEK 161,990~18,359.97 ppp	Cost savings in oral antibiotic of SEK 47,517~5385.58 ppp Cost savings in intravenous antibiotic of SEK 74,176~8407.12 ppp	Favor intervention
Le Corvoisier et al., 2013 [59] France	IG: Reduction in antibiotics prescriptions from 15.2 ± 5.4% to 12.3 ± 5.8% (−2.8% [95% CI: −3.8; 1.9]; p < 0.001) CG: Increase in antibiotics prescriptions from 15.3 ± 6.0% to 16.4 ± 6.7% (+1.1% [95% CI; 0.4; 1.8], p < 0.01)	Cost analysis	Cost of antibiotic prescriptions in CG: EUR 393 (95% CI: 201; 585)~429.04 (95% CI: 219.43; 638.65) ppp	Cost of antibiotic prescriptions in IG: -EUR 313 (95% CI: −512; −113)~341.70 (95% CI: −558.95; −123.36) ppp	NR	Significant reduction (EUR 80~87.34 ppp) in antibiotic prescription cost (p < 0.001)	Favor intervention
Madridejos-Mora et al., 2004 [67] Spain	Antibiotics over prescription: -IG (individualised feedback group): Pre, 16.4 (SD: 7.27); Post, 16.4 (SD: 6.15); p = 0.986 -CG (minimal intervention group): Pre, 15.7 (SD: 8.44); Post, 13.7 (SD: 6.81); p = 0.006	Cost analysis	Antibiotics cost in CG: Pre, 3.18 (SD: 1.59) EUR/inhabitant~4.15 (SD: 2.08) ppp/inhabitant Post, 3.25(SD: 1.31) EUR/inhabitant~4.24 (SD: 1.71) ppp/inhabitant	Antibiotics cost in IG: Pre, 2.94 (SD: 1.89) EUR/inhabitant~3.84 (SD: 2.47) ppp/inhabitant Post, 2.49 (SD: 1.42) EUR/inhabitant~3.25 (SD: 1.85) ppp/inhabitant	NR	Significant reduction (EUR −0.45~0.59 ppp/inhabitant) in antibiotic prescription cost (p = 0.004)	Favor intervention
March-Lopez et al., 2020 [68] Spain	-A decrease from 26.99 to 22.41% (−4.57%; p < 0.05) in antibiotic consumption -An increase from 31.32 to 32.35% (+1.04%; p < 0.05) in narrow-spectrum antibiotics	Cost analysis	Total antibiotic spending in 2016 (control): EUR 905,700.76~1,444,498.82 ppp	Total antibiotic spending in 2018 (sustainability phase): EUR 793,765.89~1,265,974.31 ppp	NR	Cost savings in antibiotic spending: EUR 111,934.87~178,524.51 ppp	Favor intervention
McNulty et al., 2000 [43] UK	-IG (workshop group): a reduction of −2458 (−3.4%) in antibiotics units; a reduction of −139 (−0.9%) in narrow-spectrum antibiotics; a reduction of −1612 (−15.4%) in broad-spectrum antibiotics -CG (non-workshop group): a reduction of −1209 (−2.2%) in antibiotics units; a reduction of −1248 (−11.7%) in narrow-spectrum antibiotics; an increase of 561 (6.5%) in broad-spectrum antibiotics	Cost analysis	CG: an increase of GBP 8710~12,354.61 ppp (3.8%) in antibiotics units; a reduction of -GBP 1160~1645.39 ppp (−10.8%) in narrow- spectrum antibiotics; an increase of GBP 7100~10,070.92 ppp (8.8%) in broad-spectrum antibiotics	IG: a reduction of -GBP 3400~4822.70 ppp (−3.4%) in antibiotics units; an increase of GBP 220~312.06 ppp (1.5%) in narrow- spectrum antibiotics; a reduction of GBP 8330~11,815.60 ppp (−9.3%) in broad-spectrum antibiotics	NR	-Cost savings in antibiotic units of 3.8% (NS) -Cost savings in broad-spectrum antibiotics of −9.3% (p < 0.001) -Cost increase in narrow-spectrum antibiotics of 1.5% (p = 0.016)	Favor intervention
Me’emary et al., 2009 [66] Syria	-CG (baseline survey group): 86.5% of antibiotic prescriptions; SYP 356,223~NA ppp of total antibiotics cost -IG (impact survey group): 62.8% of antibiotic prescriptions; SYP 157,182~NA ppp of total antibiotics cost	Cost analysis	CG: 66.5% of total antibiotics cost	IG: 55.1% of total antibiotics cost	NR	Cost savings of −17.1% (p < 0.001) in antibiotics cost	Favor intervention
Michaelidis et al., 2015 [48] USA	-IG1 (printed decision support): 3.78 antibiotic prescriptions per 5 cases of disease; <1.9 days of work loss compared to CG; -IG2 (computerized decision support): 3.94 antibiotic prescriptions per 5 cases of disease -CG (usual care): 4.60 antibiotic prescriptions per 5 cases of disease	Cost effectiveness analysis	NR	NR	-IG1: USD 2574~2574 ppp -IG2: USD 2802~2802 ppp -CG: USD 2768~2768 ppp	The IG1 showed to be the most cost-effective strategy to reduce antibiotic use, specifically safely avoiding antibiotics prescriptions of −0.16 and −0.82 (incremental effectiveness) compared to IG2 and CG	Favor intervention
Naughton et al., 2008 [60] Ireland	Immediate response: -IG1 (postal bulletin group): decrease of −0.02 (−0.04; −0.001) in APR; increase of 0.02 (0.002; 0.05) in first-line antibiotics; decrease in second-line antibiotics of −0.03 (−0.05; −0.01) in co-amoxiclav and −0.02 (−0.03; −0.007) in cephalosporins -IG2 (academic detailing group): decrease of −0.02 (−0.03; −0.001) in APR; increase of 0.05 (0.01; 0.09) in first-line antibiotics; decrease in second-line antibiotics of −0.03 (−0.05; −0.01) in co-amoxiclav and −0.02 (−0.03; −0.003) in cephalosporins	Cost effectiveness analysis	NR	NR	Total cost of implementation in IG1 was EUR 210,000~222,457.61 ppp with a cost per GP practice of EUR 175~185.38 ppp Total cost of implementation in IG2 was EUR 1,868,000~1,978,814 ppp with a cost per GP practice of EUR 1556~1648.31 ppp	The cost-effectiveness ratio for the IG1 was EUR 88~93.22 ppp per %change in practice compared with EUR 778~824.15 ppp for academic detailing	Favor intervention
O’Connor et al., 1999 [39] USA	-Pre-guideline: 24% using antibiotics and 76% not using antibiotics -Post-guideline: 16% using antibiotics and 84% not using antibiotics	Cost analysis	Pre-guideline cost of initial care: USD 37.8~37.8 ppp	Post-guideline cost of initial care: USD 36.2~36.2 ppp	NR	Net savings of 4.2% (NS)	Favor intervention
Oppong et al., 2018 [54] Belgium, Netherlands, Poland, Spain, UK	-EG1 (CRP group): 222 (33.64%) antibiotic prescriptions; 0.0651 QALYs; -EG2 (Communication skills group): 303 (40.95%) antibiotic prescriptions; 0.0651 QALYs; -EG3 (CRP + communication skills group): 242 (34.13%) antibiotic prescriptions; 0.0648 QALYs -CG (Usual care): 307 (59.61%) antibiotic prescriptions; 0.065 QALYs;	Cost effectiveness analysis	Antibiotic cost: -CG: EUR 27.96~41.24 ppp	Antibiotic cost: -EG1: EUR 49.34~72.77 ppp -EG2: EUR 39.56~58.35 ppp -EG3: EUR 60.32~88.97 ppp	Cost of delivering the intervention: -EG1: EUR 11.42 (SD: 7.45)~16.84 (SD: 10.99) ppp -EG2: EUR 5.62 (SD: 3.69)~8.29 (SD: 5.44) ppp -EG3: EUR 13.43 (SD: 8.53)~19.81 (SD: 12.58) ppp	-EG3: ICER of EUR 338.89~499.84 ppp -EG1: ICER of EUR 176.53~260.37 ppp -EG2: ICER of EUR 68.80~101.47 ppp All per percentage reduction in antibiotic prescription when compared with CG	Favor intervention
Ornstein et al., 1999 [40] USA	CG (non-cost information in prescriptions): 23.85% of antibiotics prescriptions EG (cost information in prescriptions): 21.59% of antibiotics prescriptions p = 0.001	Cost analysis	CG: USD 14.51~14.51 ppp mean antibiotic prescription cost; 15.85% total prescription costs	EG: USD 16.85~16.85 ppp mean antibiotic prescription cost; 16.15% total prescription costs	The mean cost per contact: CG: 12.49 ± 29.35 $~12.49 ± 29.35 ppp EG: 13.03 ± 30.06 $~13.03 ± 30.06 ppp NS difference	An increase (USD 2.34~2.34 ppp) in mean antibiotic cost (p = 0.002) and in % of total antibiotic cost	Reject intervention
Pittenger et al., 2014 [49] USA	-A decrease of −29.4% in APR per ARI episode (absolute decrease −16.5 %points, 95% CI: −20.5; −12.5; p < 0.001) -A decrease of −9.4% in number of ARI episodes (p = 0.25) -A decrease of −17.0% in ARI primary care visits (p = 0.035)	Cost analysis	NR	NR	Cost of academic detailing per year was USD 35,192 (33,315; 37,069)~35,192 (33,315; 37,069) ppp	Cost savings related to the intervention -from the payer perspective: -avoided antibiotic prescription per year: USD 21,539 (16,317; 26,763)~21,539 (16,317; 26,763) ppp -total annual cost: USD 178,000~178,000 ppp -from the healthcare perspective: -visits avoided per year: USD 156,806 (152,358; 160,384)~156,806 (152,358; 160,384) ppp -Antibiotic costs avoided per year: USD 21,539 (16,317; 26,763)~21,539 (16,317; 26,763) ppp	Favor intervention
Schwartz et al., 2021 [2] Canada	Total antibiotic prescriptions (Relative risk): -IG1 (mailed letter on antibiotic initiation) versus CG (no letter): 0.96 (0.92; 1.01), p = 0.06 -IG2 (mailed letter on antibiotic duration) versus CG: 0.95 (0.91; 1.00), p = 0.01 -IG1 versus IG2: 0.99 (0.96; 1.02), p = 0.42 -IG1 and EG2 versus CG: 0.96 (0.92; 1.00), p = 0.02 Prolonged-duration prescriptions (>7 days) (Relative risk): -IG1 versus CG: 0.98 (0.93; 1.03), p = 0.42 -IG2 versus CG: 0.92 (0.87; 0.97), p < 0.001 -IG1 versus IG2: 0.94 (0.90; 0.98), p = 0.001 -IG1 and IG2 versus CG: 0.95 (0.91; 1.00), p = 0.02	Cost analysis	NR	Antibiotic costs (Relative risk): -IG1 versus CG: 0.97 (0.92; 1.02), p = 0.19 -IG2 versus CG: 0.94 (0.89; 0.99), p = 0.01 -IG1 versus IG2: 0.97 (0.93; 1.00), p = 0.03 -IG1 and IG2 versus CG: 0.96 (0.91; 1.00), p = 0.03	NR	The initiation letter (IG1) had no statistically significant effect. Compared with CG, the duration letter (IG2) resulted in 42 fewer antibiotic prescriptions, 24 fewer prolonged-duration prescriptions, and CAD 771~599.07 ppp in drug cost savings on average per PCP over 12 months.	Favor intervention
Walker et al., 2004 [50] USA	In 1998: 1.17 of antibiotics; 13.6% of total drugs volume In 1999: 1.08 of antibiotics; 12.1% of total drugs volume A reduction of −8.1%.	Cost analysis	In 1998: USD 19.38~19.38 ppp mean antibiotic cost per claim; 7.9% of total cost; USD 16.46~16.46 ppp mean antibiotic cost per prescription	In 1999: USD 15.09~15.09 ppp mean antibiotic cost per claim; 6.1% of total cost; USD 14.04~14.04 ppp mean antibiotic cost per prescription	NR	The average antibiotic cost per claim decreased 14.7%; The average antibiotic cost per claim decreased 22.1%; The decrease in the cost per claim for antibiotics resulted from an increase in the use of generic first-line antibiotics	Favor intervention
Wei et al., 2017 [61] China	IG (educational intervention) versus CG: -a reduction of −30% (−43 to −17) in the APR; -an increase of 2% (−1 to 5) in the multiple APR; -an increase of 5% (−10 to 20) in broad-spectrum APR; -a reduction of −8% (−20 to 5) in the intravenous APR.	Cost effectiveness analysis	CG: Antibiotic cost > Individual-Baseline: USD 0.5 (0.4)~0.5 (0.4) ppp Endline: USD 0.5 (0.4)~0.5 (0.4) ppp Cluster–Baseline: USD 0.7 (0.07)~0.7 (0.07) ppp Endline: USD 0.7 (0.06)~0.7 (0.06) ppp	IG: Antibiotic cost > Individual-Baseline: USD 0.6 (0.4)~0.6 (0.4) ppp Endline: USD 0.3 (0.4)~0.3 (0.4) ppp Cluster–Baseline: 0.7 (0.04)$~0.7 (0.04) ppp Endline: USD 0.7 (0.05)~0.7 (0.05)	NR	No significant effect of the intervention on the full prescription cost [adjusted mean difference: 0.01 (−0.03 to 0.05)] The mean antibiotic cost was significantly lower in the IG than in CG, although the crude results showed no significant difference	Reject intervention
Wei et al., 2019 [62] China	After the intervention (Antimicrobial stewardship programme > -Reduction in the APR of −49%points (95% CI: −63; −35, p < 0.0001); -A modest reduction in the broad-spectrum APR (−12%points (95% CI: −21; −4); After the follow-up> -Reduction in the antibiotic prescription rate of −36% points (95% CI: −55; −17, p < 0.0001); -A moderate reduction in the broad-spectrum APR (−20% points (95% CI: −34; −6).	Cost effectiveness analysis	Antibiotic cost in CG Baseline: USD 0.5 (±0.4)~0.5 (±0.4) ppp Post intervention: USD 0.5 (±0.4)~0.5 (±0.4) ppp Post follow-up: USD 0.5 (±0.4)~0.5 (±0.4) ppp	Antibiotic cost in IG Baseline: USD 0.6 (±0.4)~0.6 (±0.4) ppp Post intervention: USD 0.3 (±0.4)~0.3 (±0.4) ppp Post follow-up: USD 0.4 (±0.4)~0.4 (±0.4) ppp	NR	-After the intervention, a reduction in the cost of antibiotics per prescription of −0.35 (95% CI: −0.45; −0.25)$~−0.35 (95% CI: −0.45; −0.25) ppp -After the follow-up, a reduction in the cost of antibiotics of −0.26 (95% CI: −0.38; −0.13)$~−0.26 (95% CI: −0.38; −0.13) ppp	Favor intervention
Wensing et al., 2004 [65] Germany	-APR EG> baseline: 83.1%; post-intervention: 76.7% CG> baseline: 86.1%; post-intervention: 75.8% -Recommended Antibiotics EG> baseline: 46.3%; post-intervention: 47.2% CG> baseline: 43.6%; post-intervention: 44.6%	Cost analysis	Antibiotic costs per prescription: CG> baseline: EUR 21.6~24.69 ppp Post-intervention: EUR 20.9~23.89 ppp	Antibiotic costs per prescription: EG> baseline: EUR 22.5~25.71 ppp Post-intervention: EUR 21.2~24.23 ppp	NR	The intervention effect on antibiotic cost was a decrease of EUR −0.92~1.05 ppp (p < 0.20)	Favor intervention
Zang et al., 2018 [63] China	CG> APR: 70 (SD: 14); 4.79 (SD: 1.64) of total healthcare cost; EG> APR: 40 (SD: 19); 5.16 (SD: 1.94) of total healthcare cost; Difference of −29 (95% CI: −42; −16, p < 0.001) in APR and 1.02 (95% CI: −0.36; 2.4; p > 0.05)	Cost effectiveness analysis	Cost per %point decrease in APR in CG: USD 4.83~4.83 ppp	Cost per %point decrease in APR in EG > USD 5.33~5.33 ppp Incremental cost per percentage point reduction in APR: USD 1.02 (−0.36; 2.4)~1.02 (−0.36; 2.4) ppp	USD 390.65 (SD: 145.68)~390.65 (SD 145.68) ppp per facility, including doctors training and information resources for patients	The APR in the IG reduced by 29.23% points at an additional cost of USD 1.02 (−0.36; 2.4)~1.02 (−0.36; 2.4) ppp per patient compared to the CG, producing an ICER of USD 0.03~0.03 ppp per %point reduction in APR	Favor intervention

NS, non-significant; CI, confidence interval; +, plus; SD, standard deviation; Quality-adjusted life years (QALYs); CRP, C-reactive protein; %, percentage; APR, antibiotic prescription rate; IG, intervention group; CG, control group; DDD, defined daily doses; ppp, purchasing power parities; NA, not available; GP, general practitioner.