Mailed Audit and Feedback for Antibiotic Prescribing in Primary Care

A 2026 economic evaluation published in JAMA Network Open assessed the cost-effectiveness of an antibiotic audit-and-feedback (A&F) program targeting primary care physicians in Ontario, Canada. The intervention involved sending physicians letters comparing their antibiotic prescribing rates with those of their peers and highlighting the risks of unnecessary antibiotic use. Using data from a randomized trial with 4,879 physicians, the study found that the program reduced antibiotic prescribing by about 5% and generated substantial economic benefits: for every CAD $1 invested, the health system saved about CAD $8.82 through reduced antibiotic use, fewer adverse drug events, and avoided health-care costs. Because the program costs only about $5.50 per physician and showed a 93% probability of producing a positive return on investment, the authors conclude that simple, scalable audit-and-feedback interventions can be a highly cost-effective component of antimicrobial stewardship programs in primary care and may help curb antimicrobial resistance.