Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use

Abstract

BackgroundAntimicrobial resistance (AMR) poses a colossal threat to global health and incurs high economic costs to society. Economic evaluations of antimicrobials and interventions such as diagnostics and vaccines that affect their consumption rarely include the costs of AMR, resulting in sub-optimal policy recommendations. We estimate the economic cost of AMR per antibiotic consumed, stratified by drug class and national income level.MethodsThe model is comprised of three components: correlation coefficients between human antibiotic consumption and subsequent resistance; the economic costs of AMR for five key pathogens; and consumption data for antibiotic classes driving resistance in these organisms. These were used to calculate the economic cost of AMR per antibiotic consumed for different drug classes, using data from Thailand and the United States (US) to represent low/middle and high-income countries.ResultsThe correlation coefficients between consumption of antibiotics that drive resistance in S. aureus, E. coli, K. pneumoniae, A. baumanii, and P. aeruginosa and resistance rates were 0.37, 0.27, 0.35, 0.45, and 0.52, respectively. The total economic cost of AMR due to resistance in these five pathogens was $0.5 billion and $2.9 billion in Thailand and the US, respectively. The cost of AMR associated with the consumption of one standard unit (SU) of antibiotics ranged from $0.1 for macrolides to $0.7 for quinolones, cephalosporins and broad-spectrum penicillins in the Thai context. In the US context, the cost of AMR per SU of antibiotic consumed ranged from $0.1 for carbapenems to $0.6 for quinolones, cephalosporins and broad spectrum penicillins.ConclusionThe economic costs of AMR per antibiotic consumed were considerable, often exceeding their purchase cost. Differences between Thailand and the US were apparent, corresponding with variation in the overall burden of AMR and relative prevalence of different pathogens. Notwithstanding their limitations, use of these estimates in economic evaluations can make better-informed policy recommendations regarding interventions that affect antimicrobial consumption and those aimed specifically at reducing the burden of AMR.Electronic supplementary materialThe online version of this article (10.1186/s13756-018-0384-3) contains supplementary material, which is available to authorized users.

Quantifying the economic cost of antibiotic resistance and the impact of related interventions: rapid methodological review, conceptual framework and recommendations for future studies

“…A separate approach has been to rely on national [48,52,53,55] or global [19,20] surveillance databases rather than individual sites. This offers greater external validity but may only be accurate in countries with representative patient data on healthcare utilisation, prescribing and antibiotic susceptibility, ideally linked to account for dependencies in these variables.…”

“…However, few studies have considered the potential impact of antibiotic consumption on (1) reducing ABR by preventing onward transmission of a bacteria susceptible to the antibiotic (positive externality) and/or (2) inducing ABR by increasing selective pressure (negative externality). Some studies have captured these externalities using descriptive statistical approaches such as (1) using empirical data to evaluate the impact of a discrete intervention affecting antibiotic consumption (such as introduction of a stewardship programme) on ABR prevalence or treatment cost [64]; (2) estimating a fixed ratio between antibiotic consumption and ABR costs (or an intermediate proxy such as ABR prevalence or hospital bed-days used to treat infection with a particular pathogen) [54]; or (3) fitting a statistical model, such as linear correlation between antibiotic consumption and ABR costs (or an intermediate proxy), using data sampled over several countries and/or years [52].…”

Antibacterial effects of low-temperature plasma generated by atmospheric-pressure plasma jet are mediated by reactive oxygen species

“…global scale. Finally, aside from the medical obstacles posed by treatment of patients with bacterial infections, the spread of antibiotic resistance also results in significant excess healthcare system costs and economic burdens with estimates of up to $1 billion per year and $3 trillion in worldwide gross domestic product losses respectively 5,6 .…”

Effect of Pediatric Influenza Vaccination on Antibiotic Resistance, England and Wales

“…We adopted a published cost estimate of $1,415 per resistant infection (2016 USD) ( 10 ), adjusted for inflation and healthcare purchasing power parity to £520 (2015 GBP).…”