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.
Modelling and Economics Unit, National Infections Service, Public Health England, London, UK.
BMC Med. 2020 Mar 6;18(1):38. doi: 10.1186/s12916-020-1507-2.
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.
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.
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.
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.
抗生素耐药性（ABR）对全球健康和经济福祉构成重大威胁。减少 ABR 需要政府采取干预措施，激励抗生素开发、审慎使用抗生素、感染控制以及部分替代品（如快速诊断和疫苗）的部署。这些干预措施的规模需要根据 ABR 经济成本的准确和全面估计来进行校准。
根据先前强调该领域方法学缺陷的文献和其他推导性流行病学和经济学推理，制定了一个用于估计归因于 ABR 的成本的概念框架。该框架通过快速方法学审查进行了补充。
该审查确定了 110 篇定量评估 ABR 成本的文章。大多数研究仅在高收入国家进行（91/110），在医院进行（95/110），采用医疗保健提供者或支付者的视角（97/110），并使用匹配队列方法比较抗生素耐药感染和抗生素敏感感染（或无感染）患者的成本（87/110）。在进行这种比较时，需要更好地利用方法来纠正偏差和混杂因素。研究结果还需要扩展到其在（1）时间（将当前成本预测到未来）、（2）视角（从医疗保健部门扩展到整个社会和经济）、（3）范围（从个人扩展到社区和生态系统）和（4）空间（从单一地点扩展到国家和世界）方面的局限性之外。还需要对干预措施的影响进行分析，以考察干预措施对 ABR 的影响，而不是将 ABR 视为外生因素。
量化耐药的经济成本将需要在使用现有方法设计研究方面更加严格和创新，这些研究能够准确收集相关结果，并进一步研究捕获更广泛经济结果的新技术。
