New Practical Tool Helps Estimate Clinical, Economic Burden of Antimicrobial Resistance

In an effort to raise awareness of antimicrobial resistance (AMR) and to elevate the roles of infection prevention, stewardship, surveillance, and the health care professionals who manage these programs, a group of researchers developed a practical tool that estimates both the clinical and economic burden of AMR within an acute care setting. This research was presented during a poster session at the ISPOR 2019 annual meeting. 

“[AMR] is projected to cause 10 million deaths annually, and cost up to $100 trillion globally by 2050,” wrote Chelsea Smallwood, MSc, associate director of health economics and public policy at BD, Toronto, Canada, and colleagues. “In order to make a business care for funding, health care facilities have been encouraged to quantify the cost of infections. Data demonstrating the clinical and economic impact of AMR at local levels is not well captures and analyzed. Even fewer tools present this data in an actionable manner.” 

In an effort to develop a practical tool for evaluating the clinical and economic burden of AMR within the acute care setting for five resistant organisms—Klesbsiella pneumonia, Escherichia coli, Enterococcus faecium, Pseudomonas aeruginosa, and Staphylococcus aureus—Ms Smallwood and her colleagues developed an economic model using data from literature and data extracted from hospital-generated antibiograms at a 442-bed hospital in Ontario. They included both direct and indirect costs per year attributed to acute care facilities. Further, the team of researchers included three future rates for resistance: low (20%), medium (50%), and high (100%). 

“The number of isolates extracted from hospital-generated antibiograms was use as a proxy for total number and distribution of relevant infections,” Ms Smallwood and colleagues wrote. “From antibiograms, a total of 2605 non duplicate isolates were identified. This is a proxy as not all patients with symptoms of an infection have a culture-confirmed diagnosis.” 

The researchers noted that some organisms may have been isolated due to colonization and do not represent a true infection, so they took a conservative approach and estimated that roughly 705 of isolates are representative of true infections. 

According to the findings, the top five infections cost $9.9 million to manage at an acute care center. The researchers found that the cost of resistant infections was $2.1 million and the incremental cost of resistance is $1.1 million. 

The researchers also found that the number of deaths from the observed infections totaled 149. The research team said that of those deaths, 104 were from susceptible infections and 45 were due to resistant infections. “At 100% resistance, the burden could rise to as much as $30 million and nearly 700 deaths,” Ms Smallwood and colleagues said. “The avoidable costs if resistance is prevented could be $18 million.” 

Ms Smallwood and colleagues concluded that with increasing resistance, the increase in costs related to infections would also be attributable to resistance. They noted that the main limitation of their study is the lack of published data that details incremental costs of resistance infections compared to susceptible infections. 

“Estimating the clinical and economic impact of AMR is critical to raising awareness of AMR, and to elevate the roles of infection prevention, stewardship, surveillance, and the health care professionals who manage these programs,” the research team concluded. “This tool delivers the ability to estimate the clinical and economic burden of AMR within an acute care setting. Efforts should be made to improve surveillance and accessibility of data to support micro-costing initiatives.” 

Ms Smallwood and her colleagues explained that this tool can be used to identify gaps in data availability as well as initiate partnerships to generate evidence and customize the inputs for the facility or region. —Julie Gould