Siaba Sabela, Casal Bruno, López-Martínez Iván
Department of Economics, Faculty of Economics and Business, Universidade da Coruña, Campus de Elviña, 15008, A Coruña, Spain.
Appl Health Econ Health Policy. 2025 Aug 30. doi: 10.1007/s40258-025-01001-7.
Antibiotic resistance (ABR) is a growing global health threat; reliable evidence on its impact is crucial for prioritising public health interventions.
This study provides an updated, systematic review and meta-analysis to determine the true effect size of resistant infections on economic and clinical outcomes. It also evaluates methodologies used in ABR economic literature, offering recommendations for improving future research.
Following PRISMA guidelines, 11,252 articles published between 2000 and 2022 were reviewed from several databases. Studies were included if they reported the economic costs of ABR in humans and compared resistant with susceptible infections. Meta-analyses were conducted using random intercept models; standardised mean difference (SMD) was used for length of stay, and odds ratio (OR) for mortality. The Mantel-Haenszel method was applied to obtain pooled estimates.
Results showed that 73% of the studies were conducted in high-income economies, the majority were performed at tertiary care settings (71%) and 67% employed only a hospital perspective. The available evidence indicated that the attributable cost of resistant infections ranged from EUR - 21,629 to EUR 74,452 per patient episode (with Pseudomonas spp. causing the highest costs). The majority of studies (93%) found that patients with ABR incurred higher costs than their susceptible counterparts (72% report statistically significantly higher costs). Results from meta-analysis indicated that, on average, the excess in hospital stay attributable to resistant infections was 8.72 days (95% confidence interval (CI) [6.42; 11.02], SMD = 0.91) and the odds of premature death were significantly higher in the resistance group, with a risk increase of 65% (OR 95% CI [1.44; 1.88]). Conclusion The findings of this study take the first steps in providing reliable evidence; they could be valuable to researchers, policymakers and clinicians involved in ABR control and health promotion across countries. Similarly, the reported estimates may prove useful for future modelling studies aimed at assessing the long-term economic impact of ABR.
抗生素耐药性（ABR）对全球健康构成的威胁日益严重；关于其影响的可靠证据对于确定公共卫生干预措施的优先级至关重要。
本研究提供了一项更新的系统评价和荟萃分析，以确定耐药感染对经济和临床结局的真实效应大小。它还评估了ABR经济学文献中使用的方法，为改进未来研究提供建议。
遵循PRISMA指南，从多个数据库中检索了2000年至2022年间发表的11252篇文章。如果研究报告了人类ABR的经济成本，并将耐药感染与易感感染进行了比较，则纳入研究。使用随机截距模型进行荟萃分析；住院时间采用标准化均数差（SMD），死亡率采用比值比（OR）。采用Mantel-Haenszel方法获得合并估计值。
结果显示，73%的研究在高收入经济体中进行，大多数研究在三级医疗机构开展（71%），67%仅从医院角度进行研究。现有证据表明，耐药感染的归因成本为每位患者每次发作21629欧元至74452欧元（铜绿假单胞菌导致的成本最高）。大多数研究（93%）发现，ABR患者的成本高于易感患者（72%报告成本在统计学上显著更高）。荟萃分析结果表明，平均而言，耐药感染导致的住院时间延长为8.72天（95%置信区间[CI][6.42；11.02]，SMD = 0.91），耐药组过早死亡的几率显著更高，风险增加65%（OR 95% CI[1.44；1.88]）。结论本研究结果迈出了提供可靠证据的第一步；它们可能对参与各国ABR控制和健康促进的研究人员、政策制定者和临床医生有价值。同样，报告的估计值可能对未来旨在评估ABR长期经济影响的建模研究有用。
