Attributable Patient Cost of Antimicrobial Resistance: A Prospective Parallel Cohort Study in Two Public Teaching Hospitals in Ghana

Abstract

Objective The aim of this study was to evaluate the attributable patient cost of antimicrobial resistance (AMR) in Ghana to provide empirical evidence to make a case for improved AMR preventive strategies in hospitals and the general population. Methods A prospective parallel cohort design in which participants were enrolled at the time of hospital admission and remained until 30 days after the diagnosis of bacteraemia or discharge from the hospital/death. Patients were matched on age group (± 5 years the age of AMR patients), treatment ward, sex, and bacteraemia type. The AMR cohort included all inpatients with a positive blood culture of Escherichia coli or Klebsiella spp., resistant to third-generation cephalosporins (3GC), or methicillin-resistant Staphylococcus aureus (MRSA). We matched the AMR cohort (n = 404) with two control arms, i.e., patients with the same bacterial infections susceptible to 3GC or S. aureus that was methicillin-susceptible (susceptible cohort; n = 152), and uninfected patients (uninfected cohort; n = 404). Settings were Korle-Bu and Komfo Anokye Teaching Hospitals, Ghana. The outcome measures were the length of hospital stay (LOS) and the associated patient costs. Outcomes were evaluated from the patient perspective. Results From a total of 5752 blood cultures screened, 1836 participants had growth in blood culture, of which, based on our inclusion criteria, 426 were enrolled into the AMR cohort; however, only 404 completed the follow-up and were matched with participants in the two control cohorts. Patients in the AMR cohort stayed approximately 5 more days (95% confidence interval [CI] 4.0-6.0) and 8 more days (95% CI 7.2-8.6) compared with the susceptible and uninfected cohorts, respectively. The mean extra patient cost due to AMR relative to the susceptible cohort was US$1300 (95% CI 1018-1370), of which about 30% resulted from productivity loss due to presenteeism and absenteeism from work. Overall, the estimated annual patient cost due to AMR translates to about US$1 million and US$1.4 million when compared with the susceptible and uninfected cohorts, respectively. Conclusion We have shown that AMR is associated with a significant excess LOS and patient costs in Ghana using prospective data from two public tertiary hospitals. This calls for infection prevention and control strategies aimed at mitigating the prevalence of AMR.

Antibiotic Resistance related Mortality, Length of Hospital Stay, and Disability-Adjusted Life Years at select Tertiary Hospitals in Uganda:A retrospective study

“…Our study’s finding that patients with AMR stayed 1.2 times longer in hospital than patients without AMR, is similar to finding by a study in Ghana, where AMR patients stayed 5 days and 8 days longer than patients with susceptible infections and non-infected patients respectively (19, 37). This is far more than what was found in France, where the excess length of stay due to AMR was only 1.6 days, and 2.9 days in Australia (38, 39).…”

An Assessment of the Current Level of Implementation of the Core Elements of Antimicrobial Stewardship Programs in Public Hospitals in Ghana

“…We also believed it was necessary to evaluate the barriers and facilitators of ASPs among hospital in Ghana to guide policies and strategies toward achieving the Ghana NAP goals to fight the rising rate of AMR and its impact on the healthcare system. [43][44][45][46] With respect to the 7 core elements of implementing sustainable ASPs. 15,21 leadership commitment emphasizes the necessity of a health facility having dedicated time, financial and human resources as well as prioritizing AMS activities to enhance appropriate antibiotic use.…”

“…We also believed it was necessary to evaluate the barriers and facilitators of ASPs among hospital in Ghana to guide policies and strategies toward achieving the Ghana NAP goals to fight the rising rate of AMR and its impact on the healthcare system. 43 - 46 …”

Healthcare provider cost of antimicrobial resistance in two teaching hospitals in Ghana

“…We matched the participants in the AMR cohort with two control arms, that is, patients with the same bacterial infections non-resistant to 3GC or methicillin (susceptible cohort) and uninfected patients (uninfected cohort). Briefly, for each new AMR patient included, we sought out one susceptible and one uninfected patient based on age group (±5 years), admission ward, gender and bacteraemia type for susceptible AMR patients ( Otieku et al. , 2023 ).…”

“…As described in the study on the patient cost of AMR ( Otieku et al. , 2023 ), denominator data were collected in person from patients by trained hospital staff (intern nurses) using a computer-assisted personal interviewing tool embedded with a validated data collection protocol design with CS Pro version 7.6.0 software.…”