Background Antimicrobial resistance (AMR) is accelerated by widespread and inappropriate use of antimicrobials. Many countries, including those in low- and middle- income contexts, have started implementing interventions to tackle AMR. However, for many interventions there is little or no economic evidence with respect to their cost-effectiveness. To help better understand the scale of this evidence gap, we conducted a systematic literature review to provide a comprehensive summary on the value for money of different interventions affecting AMR. Methods A systematic literature review was conducted of economic evaluations on interventions addressing AMR. a narrative synthesis of findings was produced. Systematic searches for relevant studies were performed across relevant databases and grey literature sources such as unpublished studies, reports, and other relevant documents. All identified economic evaluation studies were included provided that they reported an economic outcome and stated that the analysed intervention aimed to affect AMR or antimicrobial use in the abstract. Studies that reported clinical endpoints alone were excluded. Selection for final inclusion and data extraction was performed by two independent reviewers. A quality assessment of the evidence used in the included studies was also conducted. Results 28,597 articles were screened and 35 articles were identified that satisfied the inclusion criteria. The review attempted to answer the following questions: (1) What interventions to address AMR have been the subject of an economic evaluation? (2) In what types of setting (e.g. high-income, low-income, regions etc.) have these economic evaluations been focused? (3) Which interventions have been estimated to be cost-effective, and has this result been replicated in other settings/contexts? (4) What economic evaluation methods or techniques have been used to evaluate these interventions? (5) What kind and quality of data has been used in conducting economic evaluations for these interventions? Discussion The review is one of the first of its kind, and the most recent, to systematically review the literature on the cost-effectiveness of AMR interventions. This review addresses an important evidence gap in the economics of AMR and can assist AMR researchers’ understanding of the state of the economic evaluation literature, and therefore inform future research. Systematic review registration PROSPERO (CRD42020190310).

No abstract

For the past decade, Thailand has had intensively installed Fluorescent Lamp (FL) for lighting purposes. Improper handling or disposal of a spent fluorescent lamp can cause not only environmental damage by releasing mercury and other metals to the environment but also human health impact. Master Plan on Solid Waste Management (2016-2021) of Thailand encouraged industrial waste management to reduce such impacts with less consideration of the social challenges experienced by the formal recyclers that might offset the sustainability of the recycling process. This research aimed to identify enabling factors to improve the recycling process of SFLs using environmental life cycle assessment (ELCA) with SimaPro 8 and ReCiPe impact analysis, and social impact assessment (SIA) using UNEP/SETAC 2009 Guideline combined with semi-structured interviews with the formal recycling business representatives (n=2). The results showed that electricity consumption in the process contributed adversely to human health (14.96 µPt), ecosystem damage (0.74 µPt), and resource depletion (0.0086 µPt). Contrary, it has positive impacts on decent working conditions. In addition, the formal business struggled with the low material supply. The results displayed limited information on mercury impacts due to data availability and confirmation with other stakeholders. The research suggested that institutional capacity to comply with environmental and occupational safety standards supported with informal-formal partnership and sustainable financing schemes is the enabling factor to improve the recycling process in Thailand

No abstract