Superbugs II: how should economic evaluation be conducted for interventions which aim to contain antimicrobial resistance?

Abstract

To date, there has been little examination of the problems associated with conducting economic evaluation for interventions designed to contain antimicrobial resistance. There are two quite different types of intervention aimed at containing antimicrobial resistance: interventions which are designed to avoid the emergence of resistant organisms; and interventions that are designed to avoid the transmission of resistance organisms. Four aspects of economic evaluation where the ease of assessment might be expected to differ across evaluations for these different types of intervention are examined: problems associated with the identification of diffuse impacts, problems associated with comparing current and future impacts, problems associated with uncertainty, and problems associated with difficulties in measurement and valuation. The paper suggests that it may be much easier to conduct rigorous economic evaluations for interventions designed to avoid transmission of resistance, than for those intended to avoid emergence. Unfortunately, the transmission policies, which are likely to be the easiest to evaluate, are not likely to produce an optimal long-term outcome given the apparent irreversibility of much resistance and the potentially severe harms which could be imposed as a result. Given the desirability of avoiding a scenario where, in the evidence-based medicine culture, the most rigorously evaluated policies are followed even though they may be less important, there is the need to consider carefully what, and how, economic evaluation should be conducted in the area of antimicrobial resistance. It is suggested that research should focus on the use of modelling as a means of evaluating optimal policy responses and on trying to resolve some of the difficulties associated with measurement and valuation.

Pattern of use of antibiotics in hospitalized patients in the medicine department of a tertiary care hospital

“…As a result, antibiotic resistance increases the economic burden for both patient and the society. 4,5 This was confirmed by a study that showed an association of 29.3% higher total hospital cost for each admission and a 23.8% increase in the length of stay among patients infected with hospitalacquired infection (HAI) caused by a resistant Gramnegative bacteria compared to those with HAIs caused by nonresistant pathogens. 6 In addition the most common used antibiotics namely ß-lactam antibiotics, fluoroquinolones, glycopeptides, antitubercular drugs, imidazoles, and other antimicrobials have been shown to contribute toward nearly 48.7% of all the reported adverse drug reactions (ADRs).…”

Unnecessary Antibiotics

“…And resistant infections are harder to treat [5]. In one study, Coast has articulated the difficulty of estimating the aggregate, long-term harm to the population because of diffuse nature of the effects, comparison of current and future benefits and harms, uncertainty about the future course of resistance, and the possible development of new antibacterial agents, among other reasons [6]. Thus, the harm of any individual course of antibiotic (appropriate or not) is unknown, but small.…”

Resistance‐induced antibiotic substitution

“…Prices are allowed to vary with resistance levels because antibiotic manufacturers with market power may increase prices if close substitutes are less effective due to resistance. Equation (6) can be rewritten to separate resistance-attributable costs into two components:…”