The costs of antimicrobial resistance

  • The costs of antimicrobial resistance

What might the economic costs of antibiotic/antimicrobial-resistant infections be in New Zealand? The simple answer is – we don’t know. As far as I’m aware, there’s been no New Zealand studies publicly disseminated on this topic. Therefore, we have to look overseas for reported studies.

While the US Centers for Disease Control and Prevention (2013) stated the total economic cost of antibiotic-resistant infections to the US economy was difficult to calculate, they cited year 2000 estimates provided by the Alliance for the Prudent Use of Antibiotics (APUA), an international non-governmental organisation. Based on ~900,000 cases of antibiotic-resistant infections a year, the APUA estimates ranged as high as US$20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as US$35 billion a year.  Given the number of cases reported has more than doubled over the past decade – CDC recently estimated that over 2,049,442 people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying annually, who could once be easily cured – costs will have risen substantially. Furthermore, drug resistance related to viruses such as HIV and influenza was not included, nor was drug resistance among parasites such as those that cause malaria, so the true costs are likely even higher.

More recently, the UK government commissioned a review on antimicrobial resistance, in 2014, chaired by macroeconomist Jim O’Neill. As part of the two-year independent review, they estimated  losses to the world economy caused by reductions to the size and efficiency of the labour force resulting from three resistant hospital-acquired infections (Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus)  and three major infectious diseases (HIV, tuberculosis, and malaria). By 2050, they projected that in a world without effective antimicrobial therapy, gross domestic product (GDP) per capita in high-income countries would be 2.3% lower each and every year compared to a world with no resistance. An older 2005 study led by the London School of Hygiene and Tropical Medicine (Richard Smith and colleagues) estimated current losses attributable to a level of MRSA (alone) of 40% in the UK at 0.4% to 1.6% of GDP – thus suggesting the review projections might be on the low side.

The review team recognised that their projected GDP losses will be an underestimation of the overall costs of antimicrobial resistance for several reasons. First, only six conditions were included as the research team was unable to identify sufficiently robust data on others. The worldwide extent of the problem is hard to pinpoint since data are incomplete, and there’s no standard for tracking such infections and associated deaths. That also makes totaling the economic impact — and exact death count — difficult to do. Second, people may choose not to undergo certain procedures because of the heightened risks involved, resulting in further morbidity and mortality. For instance, most intensive care medicine, and surgical procedures such as caesarean sections, organ transplantations, removing tumours, and hip replacements would not be possible if you don’t have effective antibiotics available that can deal with the infections that will result – modern medicine would be paralysed. And third, costs in the healthcare system and from reduced activity in travel and trade were also not included.

It’s possible we could slice and dice the costs above and apportion them to the New Zealand population. But the different methodological approaches taken, dissimilar healthcare systems, and varying usage of antibiotics in human and animal health may mean the results are not generalisable.

Given that the dangers of resistance are widely acknowledged, why hasn’t more been done in the past? One reason is that antibiotic resistance has fallen victim to evidence-based policy making, which prioritises health problems by economic burden and cost-effectiveness of interventions. While the estimated costs of antibiotic resistance are substantial, they have not been as high as in many (competing) therapeutic areas. Thus health economists have been unable to show that antibiotic resistance costs enough to be a health priority. However, the potential future costs of a world without effective antibiotics would be much larger than the cost of antimicrobial resistance today – one could draw an analogy with climate change – though it is currently not clear to what extent, or how quickly, the future burden of antimicrobial resistance will grow. The O’Neill review stated that antimicrobial-resistant infections (due to the six above conditions) are responsible for ~700,000 deaths globally each year, with this number likely to be an underestimate due to poor reporting and surveillance. By 2050, these deaths are projected to rise to 10 million a year: more than global annual cancer deaths.

International co-ordination towards the goals outlined in the Final Report and Recommendations of the Review on Antimicrobial Resistance (just published in May) is a way forward. In the words of an esteemed UK colleague, rather than see expenditure on antimicrobial policies as a cost, we should think of it as an insurance policy against a catastrophe; albeit one which we hope will never happen.

References

  • US Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Atlanta: CDC, Department of Health and Human Services. 2013.
  • O’Neill J. Review on antimicrobial resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. 2014.
  • O’Neill J. The review on antimicrobial resistance. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations.  2016.
  • Smith RD, Yago M, Millar M, Coast J. Assessing the macroeconomic impact of a healthcare problem: The application of computable general equilibrium analysis to antimicrobial resistance. Journal of Health Economics 2005; 24(6):1055–75.

About

William Leung is a lecturer in health economics at the University of Otago, Wellington, and is currently leading the economic evaluation of SHIVERS, a CDC-funded influenza project.


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