A one health framework to estimate the cost of antimicrobial resistance

被引:38
作者
Morel, Chantal M. [1 ]
Alm, Richard A. [2 ]
Ardal, Christine [3 ]
Bandera, Alessandra [4 ,5 ]
Bruno, Giacomo M. [6 ,7 ]
Carrara, Elena [8 ]
Colombo, Giorgio L. [9 ]
de Kraker, Marlieke E. A. [10 ,11 ]
Essack, Sabiha [12 ]
Frost, Isabel [13 ]
Gonzalez-Zorn, Bruno [14 ,15 ]
Goossens, Herman [16 ]
Guardabassi, Luca [17 ]
Harbarth, Stephan [10 ,11 ,18 ]
Jorgensen, Peter S. [19 ,20 ]
Kanj, Souha S. [21 ]
Kostyanev, Tomislav [16 ]
Laxminarayan, Ramanan [13 ]
Leonard, Finola [22 ]
Hara, Gabriel Levy [23 ,24 ]
Mendelson, Marc [25 ]
Mikulska, Malgorzata [26 ,27 ]
Mutters, Nico T. [28 ]
Outterson, Kevin [2 ]
Rodriguez-Bano, Jesus [29 ,30 ]
Tacconelli, Evelina [8 ,31 ]
Scudeller, Luigia [4 ,32 ]
机构
[1] GTGL Univ Geneva, Geneva, Switzerland
[2] Boston Univ, CARB X, Rockville, MD USA
[3] Norwegian Inst Publ Hlth, Antimicrobial Resistance Ctr, Oslo, Norway
[4] Fdn IRCCS Ca Granda Osped Maggiore Policlin Milan, Infect Dis Unit, Va Francesco Sforza 28, Milan, Italy
[5] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy
[6] Bergamo Univ, Dept Management Informat & Prod Engn, Bergamo, Italy
[7] Pavia Univ, Drug Sci Dept, Pavia, Italy
[8] Univ Verona, Dept Diagnost & Publ Hlth, Infect Dis, Verona, Italy
[9] Pavia Univ, CEFAT Ctr Pharmaceut Econ & Med Technol Evaluat, Drug Sci Dept, Pavia, Italy
[10] Geneva Univ Hosp, Infect Control Program, Geneva, Switzerland
[11] Fac Med, Geneva, Switzerland
[12] Univ KwaZulu Natal, Coll Hlth Sci, Antimicrobial Res Unit, Durban, South Africa
[13] Ctr Dis Dynam Econ & Policy, New Delhi, India
[14] Univ Complutense Madrid, Dept Anim Hlth, Antimicrobial Resistance Unit, Madrid, Spain
[15] Univ Complutense Madrid, VISAVET, Madrid, Spain
[16] Univ Antwerp, Lab Med Microbiol, Antwerp, Belgium
[17] Univ Copenhagen, Dept Vet & Anim Sci, Copenhagen, Denmark
[18] Geneva Univ Hosp, Div Infect Dis, Geneva, Switzerland
[19] Royal Swedish Acad Sci, Stockholm Resilience Ctr, Global Econ Dynam & Biosphere, Stockholm, Sweden
[20] Stockholm Univ, Stockholm Resilience Ctr, Stockholm, Sweden
[21] AUBMC, Div Infect Dis, Antimicrobial Stewardship Program, Infect Control & Prevent Program, Beirut, Lebanon
[22] Univ Coll Dublin, Sch Vet Med, Vet Pathobiol, Dublin, Ireland
[23] Hosp Durand, Infect Dis Unit, Buenos Aires, DF, Argentina
[24] Univ Maimonides Buenos Aires, Infect Dis & Clin Microbiol, Buenos Aires, DF, Argentina
[25] Univ Cape Town, Groote Schuur Hosp, Dept Med, Div Infect Dis & HIV Med, Cape Town, South Africa
[26] Univ Genoa, Div Infect Dis, Genoa, Italy
[27] San Martino Hosp, Genoa, Italy
[28] Bonn Univ Hosp, Inst Hyg & Publ Hlth, Bonn, Germany
[29] Hosp Univ Virgen Macarena, Infect Dis Div, Seville, Spain
[30] Univ Seville, Biomed Inst Seville, Dept Med, Seville, Spain
[31] Tubingen Univ, Internal Med 1, Tubingen, Germany
[32] IRCCS Policlin San Matteo Fdn, Pavia, Italy
关键词
Antimicrobial resistance; Cost; One health; STEWARDSHIP;
D O I
10.1186/s13756-020-00822-6
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Objectives/purpose The costs attributable to antimicrobial resistance (AMR) remain theoretical and largely unspecified. Current figures fail to capture the full health and economic burden caused by AMR across human, animal, and environmental health; historically many studies have considered only direct costs associated with human infection from a hospital perspective, primarily from high-income countries. The Global Antimicrobial Resistance Platform for ONE-Burden Estimates (GAP-ONeuro) network has developed a framework to help guide AMR costing exercises in any part of the world as a first step towards more comprehensive analyses for comparing AMR interventions at the local level as well as more harmonized analyses for quantifying the full economic burden attributable to AMR at the global level. Methods GAP-ONeuro (funded under the JPIAMR 8th call (Virtual Research Institute) is composed of 19 international networks and institutions active in the field of AMR. For this project, the Network operated by means of Delphi rounds, teleconferences and face-to-face meetings. The resulting costing framework takes a bottom-up approach to incorporate all relevant costs imposed by an AMR bacterial microbe in a patient, in an animal, or in the environment up through to the societal level. Results The framework itemizes the epidemiological data as well as the direct and indirect cost components needed to build a realistic cost picture for AMR. While the framework lists a large number of relevant pathogens for which this framework could be used to explore the costs, the framework is sufficiently generic to facilitate the costing of other resistant pathogens, including those of other aetiologies. Conclusion In order to conduct cost-effectiveness analyses to choose amongst different AMR-related interventions at local level, the costing of AMR should be done according to local epidemiological priorities and local health service norms. Yet the use of a common framework across settings allows for the results of such studies to contribute to cumulative estimates that can serve as the basis of broader policy decisions at the international level such as how to steer R&D funding and how to prioritize AMR amongst other issues. Indeed, it is only by building a realistic cost picture that we can make informed decisions on how best to tackle major health threats.
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