A systematic literature review of economic evaluation studies of interventions impacting antimicrobial resistance

Abstract

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 Systematic searches for relevant studies were performed across relevant databases and grey literature sources such as unpublished studies, reports, and other relevant documents.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).

Cost-effectiveness of point-of-care diagnostics for AMR: a systematic review

“…Although this has been argued to result from difficulties in quantifying it, there is a clear need to include such costs to appropriately appreciate and compare the impact of POCTs and other AMR interventions. 19 , 20 In line with other reviews, 24 we recommend that future economic evaluations incorporate up-to-date estimates of the costs of AMR. More POCTs would dominate usual care were these wider societal costs included.…”

“…This systematic review, accordant with PRISMA guidelines, comprehensively assessed the cost-effectiveness of POCTs in reducing AMR in a range of settings, adding to existing reviews through identifying several additional studies and including LMICs. 24 , 26 …”

The Public health problem and resistant bacteria in lowand middle-income countries

“…Thus, as early as 1940, the first enzyme that allowed E. coli strains to destroy penicillin was discovered (1,5,6). Since then, the phenomenon of antimicrobial resistance (AMR) has gained momentum, becoming a significant public health problem (5,6,7).…”

“…The limited number of methods used to combat AMR, combined with the preference of LMIC patients (and others) towards self-medication, are factors that make it difficult to align with the 2015 World Health Assembly Global Action Plan on AMR goals, particularly goals 4 and 5 (2,3,22,23,37). The overuse of antibiotics in LMICs, which has increased by 65% over the last decade, resulting in the emergence of multi-drug resistant (MDR) and extensively drug-resistant (XDR) superbugs, calls for innovative measures to combat AMR at the level of every component of the ecosystem (5,7,14,19,24). The European Union also emphasizes the role of Gram-negative bacteria in the etiology of infections with antimicrobial-resistant bacteria, which supports the results of World Health Organization (WHO) reviews concerning AMR (25).…”

An agent-based model for collaborative learning to combat antimicrobial resistance: proof of concept based on broiler production in Senegal

“…Still various factors complicate the case for relevant action on AMR, notably obscure effects, including AMU economic incentives in terms of productivity and competitiveness, and the need for market-based solutions, especially given limits to regulatory supervision in animal health. Although economic studies point in this direction, for example for broiler producers in France [ 16 ], both animal health and LMIC are under-represented in economic evaluation of AMR-related interventions [ 17 ]. Still, new initiatives like the Food & Agriculture Organization of the United Nations (FAO)’s Reduce the Need for Antimicrobials in agrifood systems initiative (RENOFARM) recognize economic objectives as the key to reducing AMU by aiming to improve countries’ agrifood systems transformation through the provision of comprehensive support in the implementation of good production practices [ 18 ].…”