Kadam Abhijit, Mamulwar Megha, Bhambure Gayatri, Bembalkar Shilpa, Bapat Shraddha, Mane Arati, Rajure Shobha, Mathaiyan Jayanthi, Shafiq Nusrat, Prinja Shankar, Ramanathan Yamunadevi, Mehendale Sanjay M, Deotale Vijayshri Suresh, Khadanga Sagar, Bhattacharya Sanjay, Gogoi Gourangie, Walia Kamini, Panda Samiran, Gangakhedkar Raman, Attal Ruchita, Mandal Jharna, Ramanathan Venkateswaran, Ray Pallab, Chatterjee Susmita
National AIDS Research Institute, Pune, Maharashtra, India.
National AIDS Research Institute, Pune, Maharashtra, India
BMJ Open. 2024 Dec 22;14(12):e086505. doi: 10.1136/bmjopen-2024-086505.
Accurate estimates of incremental cost (IC) attributable to antimicrobial resistance (AMR) provide information of immense public health importance to the policy makers. Here, we present the IC from patient perspective for treating antimicrobial-resistant pathogens in India.
This cohort study was conducted in eight hospitals including government (GH), private (PH) and trust hospitals (TH), considering their ownership, geographical location and categories of cities. This study had a retrospective component, which calculated the direct cost of treating resistant and susceptible blood stream infections caused by selected WHO priority pathogens. The prospective component estimated indirect cost and financial coping strategies for the treatment of AMR. In the retrospective component, 1723 records were included and 170 patients were recruited in the prospective component.
The median total cost for management of antimicrobial-resistant infections was US$199 (IQR 89, 377) as opposed to US$109 (IQR 55, 229) for susceptible infection in GH. Our study has revealed that the ICs for (53.9%), (43.8%) and (49.7%) at GHs were higher for resistant pathogens. Pharmaceutical cost was the major contributor to IC at GHs (61.5%) and PHs (27.1%). In the prospective component, 46.5% of patients resorted to borrowing money for hospitalisation expenses and the per day median total cost for resistant and sensitive infection was estimated to be US$65 and US$35, respectively.
The current study concluded that the presence of any critical or high priority pathogens led to an increase in the direct and indirect medical costs. The IC varied with hospital type, length of stay, pathogen, comorbidities and diagnosis. Prospective studies are needed for precise understanding of variations in the costs of treating AMR infections.
准确估算抗菌药物耐药性（AMR）所致的增量成本（IC），可为政策制定者提供具有重大公共卫生意义的信息。在此，我们从患者角度呈现印度治疗抗菌药物耐药病原体的增量成本。
本队列研究在八家医院开展，包括政府医院（GH）、私立医院（PH）和信托医院（TH），综合考虑其所有权、地理位置和城市类别。本研究有一个回顾性部分，计算了治疗由世界卫生组织选定的重点病原体引起的耐药和敏感血流感染的直接成本。前瞻性部分估算了治疗AMR的间接成本和财务应对策略。回顾性部分纳入了1723条记录，前瞻性部分招募了170名患者。
在政府医院，管理抗菌药物耐药感染的总费用中位数为199美元（四分位间距89，377），而敏感感染为109美元（四分位间距55，229）。我们的研究表明，在政府医院，针对（53.9%）、（43.8%）和（49.7%）的耐药病原体，增量成本更高。药品成本是政府医院（61.5%）和私立医院（27.1%）增量成本的主要贡献因素。在前瞻性部分，46.5%的患者为支付住院费用而借钱，耐药和敏感感染的每日总费用中位数估计分别为65美元和35美元。
当前研究得出结论，任何关键或高度优先病原体的存在都会导致直接和间接医疗成本增加。增量成本因医院类型、住院时间、病原体、合并症和诊断而异。需要进行前瞻性研究以精确了解治疗AMR感染成本的变化情况。
