Table 1 Estimates of national, multinational and global costs of antibiotic resistance. Costs were inflated using local GDP deflators and converted to 2018 international dollars (I$) using purchasing power parities, both from data published by the World Bank and OECD
Study | Geography | Pathogens | Costs in original currency | Costs in 2018 I$ | Costs considered |
|---|---|---|---|---|---|
Studies in the grey literature | |||||
ECDC and EMEA [6] | EU, Iceland, Norway | S. aureus, Enterococcus spp., S. pneumoniae, E. coli, Klebsiella spp., P. aeruginosa | 1.5 bn/year EUR (2007) | 2.1 bn/year | Increased treatment costs, reduced productivity and labour supply due to morbidity and premature mortality |
KPMG [19] | EU, Iceland, Norway Global | E. coli, K. pneumoniae, S. aureus, HIV, TB, malaria | 1.6 bn/year EUR (2012) 1.66–6.08% of global GDP in 2050 | 2.3 bn/year | Increased treatment costs, reduced productivity and labour supply due to morbidity and premature mortality |
RAND Europe [20] | Global | E. coli, K. pneumoniae, S. aureus, HIV, TB, malaria | 0.5–6.0 tn USD (2011) per year in 40 years (0.14–1.9% of global GDP) | 0.6–6.8 tn per year in 40 years | Reduced labour supply and productivity due to increased morbidity, mortality and caregiving Reduced inter-sectoral transactions and trade |
World Bank [7] | Global | Any | 1.0–3.4 tn USD (2017) per year in 2030 (1.1–3.8% of global GDP) | 1.0–3.5 tn I$ per year in 2030 | Reduced labour supply due to premature mortality |
Studies in the rapid review of published literature | |||||
Chen et al. [45] | Ethiopia | S. pneumoniae | 15.8 m/year USD (2017) | 16.2 m/year | Increased treatment costs and productivity losses due to morbidity and premature mortality |
Chesson et al. [46] | USA | N. gonorrhoeae | 378 m/year USD (2016) | 395 m/year | Increased treatment costs |
de Kraker et al. [32] | 31 European countries | Bloodstream infections caused by MRSA and G3CREC | 62 m/year EUR (2007) | 87 m/year | Increased length of hospital stay |
Elbasha [47] | USA | Any | 0.4–19 bn/year USD (1996) | 0.6–29 bn/year | “Deadweight loss”: reduced antibiotic effectiveness leading to poorer treatment outcomes due to overprescribing antibiotics |
Johnston et al. [48] | United States | Multi-drug resistant organism | 2.39–3.38 bn/year USD (2017) | 2.45–3.46 bn/year | Increased treatment costs |
Lee et al. [49] | USA | Community-associated MRSA | Healthcare: 478 m/year USD (2011) Society: 2.2 bn/year USD (2011) | Healthcare: 539 m/year Society: 2.5 bn/year | Increased treatment costs and productivity loss due to morbidity and premature mortality |
Michaelidis et al. [50] | USA | Any | 4.4 bn/year USD (2013) | 4.8 bn/year | Cost of antibiotic use and stewardship |
Naylor et al. [29] | England | E. coli | Third-generation cephalosporin: 366,600/year GBP (2012) Piperacillin/tazobactam: 275,4000/year GBP (2012) | Third-generation cephalosporin: 578,000/year Piperacillin/tazobactam: 434,000 | Increased treatment costs |
Phelps [37] | USA | Any | 0.15–3 bn/year USD (1984) | 0.3–6.3 bn/year | Treatment costs, mortality |
Phodha et al. [51] | Thailand | Nosocomial infections due to five bacterial species | Healthcare: 2.3 bn/year USD (2012) Society: 4.2 bn/year USD (2012) | Healthcare: 2.5 bn/year Society: 4.6 bn/year | Increased treatment costs Increased societal costs (components not reported) |
Shrestha et al. [52] | USA and Thailand | Any | USA: 2.9 bn/year USD (2016) Thailand: 0.5 bn/year USD (2016) | USA: 3.0 bn/year Thailand:0.5 bn/year | Increased treatment costs and productivity loss due to morbidity and premature mortality |
Smith et al. [39] | UK | MRSA | 0.4–1.6% of national GDP, equivalent to 3–11 bn GBP (1995) | 6.5–24.0 bn | Reduced labour supply and productivity, leading to less capital investment and lowered productivity |
Thorpe et al. [53] | USA | Any | 2.2 bn/year USD (2016) | 2.3 bn/year I$ | Increased treatment costs due to morbidity |
Tillekeratne et al. [54] | Sri Lanka | Any | 229 m/year USD (2017) | 235 m/year | Not specified – costs extrapolated from US and Thai studies |
Touat et al. [55] | France | Gram-negative bacteria | 287 m/year EUR (2015) | 397 m/year | Increased treatment costs |
US Congress, Office of Technology Assessment [56] | USA | Nosocomial infections due to six bacterial species | 1.3 bn/year USD (1992) | 2.1 bn/year | Hospital treatment costs |
Zhen et al. [57] | China | Intra-abdominal bacterial infections | Healthcare: 37 bn/year CNY (2015) Society: 111 bn/year CNY (2015) | Healthcare: 12 bn/year Society: 35 bn/year | Increased treatment costs, 3x multiplier for societal costs |