Smith Richard D, Yago Milton, Millar Michael, Coast Joanna
School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, UK.
Appl Health Econ Health Policy. 2006;5(1):55-65. doi: 10.2165/00148365-200605010-00007.
Antimicrobial resistance (AMR) is, at least in part, associated with high antimicrobial usage and causes increased morbidity, mortality and healthcare costs. However, policies to contain AMR focus on 'micro' interventions - typically in one institution (usually a hospital). Furthermore, in evaluating these interventions, economists tend to concentrate on the economic impact to the healthcare sector alone, which may give an incorrect estimation of the social costs and benefits of a disease or intervention.
This study outlines and illustrates a macroeconomic approach to tackling AMR through the evaluation of three 'macro' policies: regulation, permits and taxes/charges. In addition to effects on the healthcare sector, the effect of AMR (and these three policies to contain it) on labour productivity, GDP, household income, government transfers, tax revenues, unemployment, inflation and social services are estimated for the UK using the specific context of methicillin-resistant Staphylococcus aureus (MRSA).
AMR is likely to have a far greater impact on the national economy than would be estimated by concentrating on the healthcare sector alone.
The permit system appears to offer the most efficient 'solution' to optimising antimicrobial consumption and, hence, reducing the development of resistance.
抗菌药物耐药性（AMR）至少部分与抗菌药物的高使用量相关，并导致发病率、死亡率上升以及医疗成本增加。然而，控制AMR的政策侧重于“微观”干预——通常在一个机构（通常是医院）内。此外，在评估这些干预措施时，经济学家往往仅关注对医疗保健部门的经济影响，这可能会对一种疾病或干预措施的社会成本和效益做出错误估计。
本研究概述并举例说明了一种通过评估三种“宏观”政策（监管、许可证和税收/收费）来应对AMR的宏观经济方法。除了对医疗保健部门的影响外，还利用耐甲氧西林金黄色葡萄球菌（MRSA）的具体情况，估计了AMR（以及这三种控制它的政策）对英国劳动力生产率、国内生产总值、家庭收入、政府转移支付、税收收入、失业率、通货膨胀和社会服务的影响。
AMR对国民经济的影响可能比仅关注医疗保健部门所估计的要大得多。
许可证制度似乎为优化抗菌药物消费从而减少耐药性的产生提供了最有效的“解决方案”。
