The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis

Constantinos I Michaelidis, Michael J Fine, Chyongchiou Jeng Lin, Jeffrey A Linder, Mary Patricia Nowalk, Ryan K Shields, Richard K Zimmerman, Kenneth J Smith, Constantinos I Michaelidis, Michael J Fine, Chyongchiou Jeng Lin, Jeffrey A Linder, Mary Patricia Nowalk, Ryan K Shields, Richard K Zimmerman, Kenneth J Smith

Abstract

Background: Ambulatory antibiotic prescribing contributes to the development of antibiotic resistance and increases societal costs. Here, we estimate the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States.

Methods: In an exploratory analysis, we used published data to develop point and range estimates for the hidden societal cost of antibiotic resistance (SCAR) attributable to each ambulatory antibiotic prescription in the United States. We developed four estimation methods that focused on the antibiotic-resistance attributable costs of hospitalization, second-line inpatient antibiotic use, second-line outpatient antibiotic use, and antibiotic stewardship, then summed the estimates across all methods.

Results: The total SCAR attributable to each ambulatory antibiotic prescription was estimated to be $13 (range: $3-$95). The greatest contributor to the total SCAR was the cost of hospitalization ($9; 69 % of the total SCAR). The costs of second-line inpatient antibiotic use ($1; 8 % of the total SCAR), second-line outpatient antibiotic use ($2; 15 % of the total SCAR) and antibiotic stewardship ($1; 8 %). This apperars to be an error.; of the total SCAR) were modest contributors to the total SCAR. Assuming an average antibiotic cost of $20, the total SCAR attributable to each ambulatory antibiotic prescription would increase antibiotic costs by 65 % (range: 15-475 %) if incorporated into antibiotic costs paid by patients or payers.

Conclusions: Each ambulatory antibiotic prescription is associated with a hidden SCAR that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.

Keywords: Antibiotic resistance; Negative externality; Primary care; Societal costs; Stewardship.

References

    1. Centers for Disease Prevention and Control. Antibiotic resistance threats in the United States. . Accessed 12 Sept 2016.
    1. Institute of Medicine . The resistance phenomenon in microbes and infectious disease vectors: implications for human health and strategies for containment. Workshop summary. Washington DC: The National Academies Press; 2003.
    1. Wise R, Hart T, Cars O, et al. Antimicrobial resistance is a major threat to public health. BMJ. 1998;317:609–610. doi: 10.1136/bmj.317.7159.609.
    1. Goosens H, Ferech M, Stichele RV, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365:579–87. doi: 10.1016/S0140-6736(05)70799-6.
    1. van de Sande-Bruinsma N, Grundman H, Verloo D, et al. Antimicrobial drug use and resistance in Europe. Emerg Infect Dis. 2008;14:1722–1730. doi: 10.3201/eid1411.070467.
    1. Donnan PT, Wei L, Steinke DT, et al. Presence of bacteriuria caused by trimethoprim resistant bacteria in patients prescribe antibiotics: multilevel model with practice and individual patient data. BMJ. 2004;328:1297–1301. doi: 10.1136/bmj.328.7451.1297.
    1. Butler C, Hillier S, Roberts Z, et al. Antibiotic-resistant infections in primary care are symptomatic for longer and increase workload: outcomes for patients with E. coli UTIs. Brit J Gen Pract. 2006;56:686–692.
    1. Hicks LA, Bartoces MG, Roberts RM, et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis. 2015;60:1308–1316.
    1. Pew Charitable Trust. Record-high antibiotic sales for meat and poultry production. . Accessed 12 Sept 2016
    1. Marshall BM, Levy SB. Food animals and antimicrobials: impacts on human health. Clin Microbiol Rev. 2011;24:718–733. doi: 10.1128/CMR.00002-11.
    1. Michaelidis CI, Zimmerman RK, Nowalk MP, Fine MJ, Smith KJ. Cost-effectiveness of procalcitonin-guided therapy for outpatient management of acute respiratory tract infections in adults. J Gen Intern Med. 2014;29:579–586. doi: 10.1007/s11606-013-2679-7.
    1. Roberts RR, Hota B, Ahmad I, et al. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect Dis. 2009;49:1175–1184. doi: 10.1086/605630.
    1. Bush K, Courvalin P, Dantas G, et al. Tackling antibiotic resistance. Nat Rev Microbiol. 2011;9:894–896. doi: 10.1038/nrmicro2693.
    1. Institute of Medicine. Antimicrobial resistance: issues and options . Workshop report. Washington DC: The National Academy Press; 1998.
    1. Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42:S82–89. doi: 10.1086/499406.
    1. Carmeli Y, Eliopoulos G, Mozaffari G, et al. Health and economic outcomes of vancomycin-resistant Enterococci. Arch Intern Med. 2002;162:2223–2228. doi: 10.1001/archinte.162.19.2223.
    1. Suda KJ, Hicks LA, Roberts RM, et al. A national evaluation of antibiotic expenditures by healthcare setting in the United States, 2009. J Antimicrob Chemother. 2013;68:715–718. doi: 10.1093/jac/dks445.
    1. Business Wire. Cubist Reports Fourth Quarter and Full Year 2012 Financial Results. . Accessed 12 Sept 2016.
    1. Wenzel R, Bate G, Kirkpatrick P. Fresh from the pipeline: tigecycline. Nat Rev Drug Discov. 2005;4:809–810. doi: 10.1038/nrd1857.
    1. Pfizer. Fourth Quarter Financial Report 2012. Available from: . Accessed 12 Sept 2016.
    1. Forest-Laboratories Third Quarter 2013 Sales. Available from . Accessed 12 Sept 2016.
    1. Inan D, Saba R, Gunseron F, et al. Daily antibiotic cost of nosocomial infections in a Turkish university hospital. BMC Infect Dis. 2005;5:5. doi: 10.1186/1471-2334-5-5.
    1. Hersh AL, Shapiro DJ, Pavia AT, et al. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128:1053–1061. doi: 10.1542/peds.2011-1337.
    1. Shapiro DJ, Hicks LA, Pavia AT, et al. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–09. J Antimicrob Chemother. 2014;69:234–240. doi: 10.1093/jac/dkt301.
    1. Kouta I, Elkin E, Blinder V, et al. Cost-effectiveness of full coverage of aromatase inhibitors for Medicare beneficiaries with early breast cancer. Cancer. 2013;119:2494–2502. doi: 10.1002/cncr.28084.
    1. GoodRx. Search Drug Prices. Available from: . Accessed 12 Sept 2016.
    1. Curtis FR, Lettrich P, Fairman KA. What is the price benchmark to replace average wholesale price (AWP)? J Manag Care Pharm. 2010;16:492–501.
    1. American Hospital Association. Fast Facts on American Hospitals. . Accessed 12 Sept 2016.
    1. Carling P, Fung T, Killion A, et al. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003;24:699–706. doi: 10.1086/502278.
    1. . Clinical Pharmacist Annual Salary. . Accessed 12 Sept 2016.
    1. . Infectious Disease Physician Annual Salary. . Accessed 12 Sept 2016.
    1. Dellit TH, Owens RC, McGowan JE, et al. Infectious Diseases Society of American and the Society for Healthcare Epidemiology of American guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159–177. doi: 10.1086/510393.
    1. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016;315(17):1864–1873. doi: 10.1001/jama.2016.4151.
    1. Gonzales R, Malone DC, Maselli JH, et al. Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis. 2001;33:757–762. doi: 10.1086/322627.
    1. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278:901–904. doi: 10.1001/jama.1997.03550110039033.
    1. Kenealy T, Arrol B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database SystRev. 2013;(6):CD000247.
    1. Smith SM, Fahey T, Smucny J, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014;(3):CD000245.
    1. Linder JA. Antibiotic prescribing for acute respiratory infections—success that’s way off the mark. JAMA. 2013;173:273–275.
    1. Phelps T. Bug/drug resistance: sometimes less is more. Med Care. 1989;27:194–203. doi: 10.1097/00005650-198902000-00009.
    1. Smith RD, Yago M, Millar M, et al. A macroeconomic approach to evaluating policies to contain antimicrobial resistance: a case study of methicillin-resistant Staphylococcus aureus (MRSA) Appl Health Econ Health Policy. 2006;5:55–65. doi: 10.2165/00148365-200605010-00007.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera