A one health framework to estimate the cost of antimicrobial resistance
Antimicrobial Resistance and Infection Control publica este artículo de investigación
26 de noviembre de 2020
Objectives/purpose: The costs attributable to antimicrobial resistance (AMR) remain theoretical and largely unspecified. Current figures fail to capture the full health and economic burden caused by AMR across human, animal, and environmental health; historically many studies have considered only direct costs associated with human infection from a hospital perspective, primarily from high-income countries. The Global Antimicrobial Resistance Platform for ONE-Burden Estimates (GAP-ON€) network has developed a framework to help guide AMR costing exercises in any part of the world as a first step towards more comprehensive analyses for comparing AMR interventions at the local level as well as more harmonized analyses for quantifying the full economic burden attributable to AMR at the global level.
Methods: GAP-ON€ (funded under the JPIAMR 8th call (Virtual Research Institute) is composed of 19 international networks and institutions active in the field of AMR. For this project, the Network operated by means of Delphi rounds, teleconferences and face-to-face meetings. The resulting costing framework takes a bottom-up approach to incorporate all relevant costs imposed by an AMR bacterial microbe in a patient, in an animal, or in the environment up through to the societal level.
Results: The framework itemizes the epidemiological data as well as the direct and indirect cost components needed to build a realistic cost picture for AMR. While the framework lists a large number of relevant pathogens for which this framework could be used to explore the costs, the framework is sufficiently generic to facilitate the costing of other resistant pathogens, including those of other aetiologies.
Conclusion: In order to conduct cost-effectiveness analyses to choose amongst different AMR-related interventions at local level, the costing of AMR should be done according to local epidemiological priorities and local health service norms. Yet the use of a common framework across settings allows for the results of such studies to contribute to cumulative estimates that can serve as the basis of broader policy decisions at the international level such as how to steer R&D funding and how to prioritize AMR amongst other issues. Indeed, it is only by building a realistic cost picture that we can make informed decisions on how best to tackle major health threats.
Keywords: Antimicrobial resistance; Cost; One health
Morel CM., Alm RA., Ardal C., Bandera A., Bruno GM., Carrara E., Colombo GL., de Kraker MEA., Essack S., Frost I., Gonzalez-Zorn B., Goossens H., Guardabassi L., Harbarth S., Jorgensen PS., Kanj SS., Kostyanev T., Laxminarayan R., Leonard F., Hara GL., Mendelson M., Mikulska M., Mutters NT., Outterson K., Rodriguez-Bano J., Tacconelli E., Scudeller L. y GAP-ONE network.
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| Boston University School of Medicine (BUSM). | |
| Antimicrobial Resistance Centre. Norwegian Institute of Public Health. | |
| Infectious Disease Unit. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano. | |
| Department of Pathophysiology and Transplantation. University of Milano. | |
| Department of Management information and production Engineering. Bergamo University. | |
| Drug science Department. Pavia University. | |
| Department of Diagnostic and Public Health. University of Verona. | |
| Center of Pharmaceuticals Economics and Medical Technologies Evaluation (CEFAT). Drug science Department. Pavia University. | |
| Infection Control Program. Faculty of Medicine. University of Geneva. | |
| Antimicrobial Research Unit. College of Health Sciences. University of KwaZulu-Natal. | |
| Center for Disease Dynamics. Economics & Policy. | |
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| Departamento de Sanidad Animal. Facultad de Veterinaria. Universidad Complutense (UCM). |
| Laboratory Medical Microbiology. University of Antwerp. | |
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| Division of Infectious Diseases. Faculty of Medicine. University of Geneva. | |
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| Stockholm University. | |
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| Infectious Diseases Unit. Hospital Durand. | |
| Infectious Diseases and Clinical Microbiology. Universidad Maimónides Buenos Aires. | |
| Department of Medicine. Groote Schuur Hospital. University of Cape Town. | |
| Division of Infectious Diseases. University of Genova and San Martino Hospital. | |
| Bonn University Hospital. Institute for Hygiene and Public Health. | |
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| Internal Medicine I. University of Tübingen. | |
| Fondazione IRCCS Policlinico San Mateo. | |
| Fundación Semana Verde de Galicia. | |
