Background <p>Although Pharmacist Early Active Consultation (PEAC) has demonstrated clinical benefits in patients with multidrug-resistant organisms (MDROs), its cost-effectiveness in China remains insufficiently studied.</p> Aim <p>This study aimed to evaluate the cost-effectiveness of PEAC in patients with MDROs from the perspective of the Chinese healthcare system.</p> Method <p>A historically controlled study was conducted on 100 MDRO-infected patients, including 37 who received PEAC and 63 who did not. The effective treatment rate and duration of the symptoms were assessed. A decision tree model was developed using model inputs derived from the study. The primary endpoints included incremental cost per MDRO treatment and incremental cost-effectiveness ratio (ICER). Uncertainty was evaluated using one-way and probabilistic sensitivity analysis.</p> Results <p>The effective treatment rate increased to 89.1% in the PEAC group compared with 62.1% in the no-consultation group. Patients in the PEAC group experienced a 2.1-day shorter duration of symptoms than those without consultation (15.5&#xa0;days vs. 17.6&#xa0;days, <i>P</i> = 0.04). The base case analysis estimated that the PEAC group gained 0.189 quality-adjusted life years (QALYs) at a cost of $18,209.7, while the no-consultation group gained 0.177 QALYs at a cost of $23,831.1. The PEAC group was more cost-effective, yielding an ICER of − $475,499.0 per QALY gained. Probabilistic sensitivity analysis indicated that PEAC was cost-effective in 60.1% of cases, with costs remaining below the willingness-to-pay (WTP) threshold, supporting PEAC as a cost-effective strategy for managing MDRO infections.</p> Conclusion <p>Pharmacist Early Active Consultation was a more cost-effective strategy than no consultation for treating MDRO infections in patients in China.</p>