Lester Rebecca, Mango James, Mallewa Jane, Jewell Christopher P, Lalloo David A, Feasey Nicholas A, Maheswaran Hendramoorthy
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
PLOS Glob Public Health. 2023 Jun 22;3(6):e0001589. doi: 10.1371/journal.pgph.0001589. eCollection 2023.
Data which accurately enumerate the economic costs of antimicrobial resistance (AMR) in low- and middle- income countries are essential. This study aimed to quantify the impact of third-generation cephalosporin resistant (3GC-R) bloodstream infection (BSI) on economic and health related quality of life outcomes for adult patients in Blantyre, Malawi. Participants were recruited from a prospective, longitudinal cohort study of hospitalised patients with bloodstream infection caused by Enterobacterales at Queen Elizabeth Central Hospital (QECH). Primary costing studies were used to estimate the direct medical costs associated with the inpatient stay. Recruited participants were asked about direct non-medical and indirect costs associated with their admission and their health-related quality of life was measured using the EuroQol EQ-5D questionnaire. Multiple imputation was undertaken to account for missing data. Costs were adjusted to 2019 US Dollars. Cost and microbiology surveillance data from QECH, Blantyre was used to model the annual cost of, and quality-adjusted life years lost to, 3GC-R and 3GC-Susceptible BSI from 1998 to 2030 in Malawi. The mean health provider cost per participant with 3GC-R BSI was US$110.27 (95%CR; 22.60-197.95), higher than for those with 3GC-S infection. Patients with resistant BSI incurred an additional indirect cost of US$155.48 (95%CR; -67.80, 378.78) and an additional direct non-medical cost of US$20.98 (95%CR; -36.47, 78.42). Health related quality of life outcomes were poor for all participants, but participants with resistant infections had an EQ-5D utility score that was 0.167 (95% CR: -0.035, 0.300) lower than those with sensitive infections. Population level burden estimates suggest that in 2016, 3GC-R accounted for 84% of annual societal costs from admission with bloodstream infection and 82% of QALYs lost. 3GC-R bloodstream infection was associated with higher health provider and patient level costs than 3GC-S infection, as well as poorer HRQoL outcomes. We demonstrate a substantial current and future economic burden to society as a result of 3GC-R E. coli and Klebsiella spp. BSI, data urgently needed by policy makers to provide impetus for implementing strategies to reduce AMR.
准确列举低收入和中等收入国家抗菌药物耐药性（AMR）经济成本的数据至关重要。本研究旨在量化第三代头孢菌素耐药（3GC-R）血流感染（BSI）对马拉维布兰太尔成年患者经济和健康相关生活质量结果的影响。参与者来自伊丽莎白女王中央医院（QECH）对由肠杆菌科引起的血流感染住院患者进行的一项前瞻性纵向队列研究。主要成本研究用于估计与住院期间相关的直接医疗成本。招募的参与者被问及与入院相关的直接非医疗和间接成本，并使用欧洲五维健康量表（EuroQol EQ-5D）问卷测量他们的健康相关生活质量。采用多重填补法处理缺失数据。成本调整为2019年美元。来自马拉维布兰太尔QECH的成本和微生物监测数据用于模拟1998年至2030年3GC-R和3GC敏感BSI的年度成本以及质量调整生命年损失。每例3GC-R BSI参与者的平均医疗服务提供者成本为110.27美元（95%置信区间；22.60 - 197.95），高于3GC-S感染患者。耐药BSI患者产生了额外的间接成本155.48美元（95%置信区间；-67.80，378.78）和额外的直接非医疗成本20.98美元（95%置信区间；-36.47，78.42）。所有参与者的健康相关生活质量结果都很差，但耐药感染参与者的EQ-5D效用评分比敏感感染参与者低0.167（95%置信区间：-0.035，0.300）。人群水平的负担估计表明，在2016年，3GC-R占血流感染入院年度社会成本的84%和质量调整生命年损失的82%。与3GC-S感染相比，3GC-R血流感染与更高的医疗服务提供者和患者层面成本以及更差的健康相关生活质量结果相关。我们证明了3GC-R大肠杆菌和克雷伯菌属BSI给社会带来的当前和未来巨大经济负担，政策制定者迫切需要这些数据来推动实施减少AMR的策略。
