Mark Jit1,2,3, Dorothy Hui Lin Ng4, Nantasit Luangasanatip5,6, Frank Sandmann5,7, Katherine E Atkins5,8, Julie V Robotham7,9,10, Koen B Pouwels7,9,11. 1. The National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. mark.jit@lshtm.ac.uk. 2. Modelling and Economics Unit, National Infections Service, Public Health England, London, UK. mark.jit@lshtm.ac.uk. 3. School of Public Health, University of Hong Kong, Hong Kong, SAR, China. mark.jit@lshtm.ac.uk. 4. Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore. 5. The National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. 6. Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. 7. Modelling and Economics Unit, National Infections Service, Public Health England, London, UK. 8. Centre for Global Health Research, The Usher Institute for Population Health Science and Informatics, The University of Edinburgh, Edinburgh, UK. 9. The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK. 10. The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK. 11. Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Abstract
BACKGROUND: Antibiotic resistance (ABR) poses a major threat to health and economic wellbeing worldwide. Reducing ABR will require government interventions to incentivise antibiotic development, prudent antibiotic use, infection control and deployment of partial substitutes such as rapid diagnostics and vaccines. The scale of such interventions needs to be calibrated to accurate and comprehensive estimates of the economic cost of ABR. METHODS: A conceptual framework for estimating costs attributable to ABR was developed based on previous literature highlighting methodological shortcomings in the field and additional deductive epidemiological and economic reasoning. The framework was supplemented by a rapid methodological review. RESULTS: The review identified 110 articles quantifying ABR costs. Most were based in high-income countries only (91/110), set in hospitals (95/110), used a healthcare provider or payer perspective (97/110), and used matched cohort approaches to compare costs of patients with antibiotic-resistant infections and antibiotic-susceptible infections (or no infection) (87/110). Better use of methods to correct biases and confounding when making this comparison is needed. Findings also need to be extended beyond their limitations in (1) time (projecting present costs into the future), (2) perspective (from the healthcare sector to entire societies and economies), (3) scope (from individuals to communities and ecosystems), and (4) space (from single sites to countries and the world). Analyses of the impact of interventions need to be extended to examine the impact of the intervention on ABR, rather than considering ABR as an exogeneous factor. CONCLUSIONS: Quantifying the economic cost of resistance will require greater rigour and innovation in the use of existing methods to design studies that accurately collect relevant outcomes and further research into new techniques for capturing broader economic outcomes.
BACKGROUND:Antibiotic resistance (ABR) poses a major threat to health and economic wellbeing worldwide. Reducing ABR will require government interventions to incentivise antibiotic development, prudent antibiotic use, infection control and deployment of partial substitutes such as rapid diagnostics and vaccines. The scale of such interventions needs to be calibrated to accurate and comprehensive estimates of the economic cost of ABR. METHODS: A conceptual framework for estimating costs attributable to ABR was developed based on previous literature highlighting methodological shortcomings in the field and additional deductive epidemiological and economic reasoning. The framework was supplemented by a rapid methodological review. RESULTS: The review identified 110 articles quantifying ABR costs. Most were based in high-income countries only (91/110), set in hospitals (95/110), used a healthcare provider or payer perspective (97/110), and used matched cohort approaches to compare costs of patients with antibiotic-resistant infections and antibiotic-susceptible infections (or no infection) (87/110). Better use of methods to correct biases and confounding when making this comparison is needed. Findings also need to be extended beyond their limitations in (1) time (projecting present costs into the future), (2) perspective (from the healthcare sector to entire societies and economies), (3) scope (from individuals to communities and ecosystems), and (4) space (from single sites to countries and the world). Analyses of the impact of interventions need to be extended to examine the impact of the intervention on ABR, rather than considering ABR as an exogeneous factor. CONCLUSIONS: Quantifying the economic cost of resistance will require greater rigour and innovation in the use of existing methods to design studies that accurately collect relevant outcomes and further research into new techniques for capturing broader economic outcomes.
Authors: Daphne S Sun; Stephen M Kissler; Sanjat Kanjilal; Scott W Olesen; Marc Lipsitch; Yonatan H Grad Journal: PLoS Biol Date: 2022-03-09 Impact factor: 8.029
Authors: Daniel M Mrochen; Patricia Trübe; Ilka Jorde; Grazyna Domanska; Cindy van den Brandt; Barbara M Bröker Journal: Front Immunol Date: 2021-04-15 Impact factor: 7.561
Authors: Ana Marta-Costa; Carla Miranda; Vanessa Silva; Adriana Silva; Ângela Martins; José Eduardo Pereira; Luis Maltez; Rosa Capita; Carlos Alonso-Calleja; Gilberto Igrejas; Patrícia Poeta Journal: Int J Environ Res Public Health Date: 2021-03-09 Impact factor: 3.390