Responding to the Antibiotic Resistance Crisis: An Economic Approach
Antibiotic resistance is an issue that has grown in severity over the past decade. According to the Tufts University Alliance for the Prudent Use of Antibiotics, the problem arises “when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria are ‘resistant’ and continue to multiply in the presence of therapeutic levels of antibiotics” (Tufts 2001). Humans propagate this process by introducing antibiotics in animal feed in the meat industry (which is then consumed by humans), prescribing antibiotics for non-bacterial illnesses, and not finishing the full course of administering antibiotics. This poses a serious threat, and has the potential to have significant economic impacts within the United States and globally. Because of the complexity of the antibiotic resistance crisis, many stakeholders and demographics face the financial repercussions both in the short- and long-term. It is important to consider the potential economic harm from the perspective of the healthcare industry, the patient, third-party payers, and the entirety of society (Eliopoulos 2003). The United States government should take steps to mitigate the antibiotic resistance crisis in order to protect individual, national, and global economic interests.
Cost of Treatment for Healthcare Industry in Present Day
The healthcare industry is a major constituent when discussing any economic matters. This is because healthcare is a critical service for the proper functioning of society, and maintaining a low cost of healthcare is essential to increasing its availability. Antibiotics, like any other drug, have high costs to manufacture, distribute, administer, and use. The cost of this process only increases when coupled with antibiotic resistance issues. When an infection becomes resistant, the costs of treatment and administration rise tremendously. Therefore, if we were able to decrease the rate at which new, resistant bacterial strains are developed, then we could curb back the rising cost of health care. Dr. George Eliopoulos of Harvard University is a professor of medicine who specializes in epidemiology and infectious diseases. In 2003, he published a paper in Oxford University’s epidemiology journal, Clinical Infectious Diseases, which is among the most significant epidemiology journals in the world with an impact factor of 8.886. In the paper, he writes “Engemann et al. demonstrated that the median hospital charge for patients with MRSA surgical site infections ($92,363) is significantly higher than the median hospital charge for those with methicillin-susceptible S. aureus surgical site infections ($52,791) and that patients with either type of infection have a significantly higher median charge than do patients without infection ($29,455)” (Eliopoulos 2003).
This provides a concrete example of resistant infections causing financial complications to the healthcare industry (and indirectly the patient) due to antibiotic resistance. MRSA surgical site infections, which are due to an ineffectiveness of antibiotics, are over three times more costly to resolve than non-infected surgical sites, revealing the magnitude of financial harm done.
Tufts University, a world-renowned medical research university, published a fact sheet regarding the costs of antibiotic resistance to patients and to healthcare providers. On page two, they write, “The medical costs per patient suffering from an antibiotic resistant (ABR) infection ranges from $18,588 to $29,069. These costs per patient total over $20 billion in health care system costs each year in the U.S” (Tufts 2010). This shows that, despite only increasing the cost of prescriptions by $13, antibiotic resistance drastically increases cost of treatment because of the duration of stay in a hospital (Tufts 2010). These studies provide a greater understanding of the cost on the healthcare system to combat antibiotic-resistant infections in the present day.
Impact on Future Economy
As time progresses, the negative economic results of antibiotic resistance will be cumulative and grow in magnitude unless steps are taken to mitigate the issue (Spellberg 2013). The RAND Corporation of Europe is dedicated to investigating the impact of policies on economic metrics. Using a dynamic general equilibrium model that factored in numerous variables (i.e region, bacterial species, present cost of treatment, number of working individuals, etc.), the corporation found that by 2050, the global GDP would drop between 0.06% and 3.1% because of antibiotic resistant infections. This results in a loss of between $2.1 trillion and $124.5 trillion (RAND 2014). This is important because the cumulative cost that human society will experience between the 2010 and 2050 is one that society may not be able to afford. In an article published by The World Bank regarding antibiotic resistance, they write, “Of the additional 28.3 million people falling into extreme poverty in 2050 in the high-impact AMR scenario, the vast majority (26.2 million) would live in low-income countries” (World Bank 2016). From these sources, it becomes evident that antibiotic resistance not only poses issues in the status quo, but it holds long-term ramifications as well. When weighing whether or not present day investments are worthwhile, it is important to consider the costs that will emerge in the future from inaction in the present.
Unaccounted and Unknown Costs
Antibiotic-resistant infections pose such a serious threat because of their capricious and varied nature. Because of this uncertainty, it is unknown the magnitude of many factors that are known to influence the cost of combatting antibiotic resistance. The World Health Organization (WHO) journal, which has an impact factor of 5.302 and publishes research on the forefronts of public health concerns, published a fact sheet presenting information regarding antibiotic resistance. The WHO stated that “The cost of health care for patients with resistant infections is higher than care for patients with non-resistant infections due to longer duration of illness, additional tests and use of more expensive drugs” (WHO 2017). This is significant information because despite not having quantifiable data on the costs, it provides insight into variables that are frequently overlooked when calculating the cost of treatment of antibiotic resistant infections. From this statement, we can extrapolate that it is indeed the presence of antibiotic resistance that is increasing patient care costs rather than a potentially different variable. The Center for Disease Control (CDC) is a leader in infectious disease management and research. At the “4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections,” Dr. John McGowan, a professor of epidemiology and medicine at Emory University, presented a chart relating various stakeholders with their attitudes toward antibiotic-resistance.
This shows that when weighing the economic impact of antibiotic resistance, many industries and parties must be considered that are overlooked in the aforementioned studies due to a lack of data. Beyond the cost for the physician and patient, the progressively growing resistance of bacteria will economically affect the drug industry and society as a whole. The uncertain costs that are attached to antibiotic-resistant infections must be accounted for when preparing an estimate for the cost of combatting resistant infections.
There is overwhelming evidence to suggest that, from an economic stance, antibiotic resistance is a growing crisis that must be responded to by the United States government. From a purely economic stance, this is noted in both the short- and long-term economic ramifications of resistant infections. However, when one broadens the lens with which they look at this issue, they realize that justification for federal intervention exists from scientific and ethical points of view as well. Millions of lives are potentially at risk from a lack of treatment for infectious agents, and the sheer nature of being an infectious disease crisis makes this even more threatening an issue. For the protection of economic interests and the American people, it is recommended that the United States government intervene in this global issue.
Antimicrobial resistance. World Health Organization. 2017 Nov.
Economic Impact of Antimicrobial Resistance — Volume 7, Number 2-April 2001 — Emerging Infectious Disease journal — CDC. Centers for Disease Control and Prevention. 2011 May https://wwwnc.cdc.gov/eid/article/7/2/70-0286_article
Eliopoulos GM, Cosgrove SE, Carmeli Y. Impact of Antimicrobial Resistance on Health and Economic Outcomes | Clinical Infectious Diseases | Oxford Academic. OUP Academic. 2003 Jun 1. https://academic.oup.com/cid/article/doi/10.1086
Estimating the Economic Costs of Antimicrobial Resistance. RAND Corporation.
International Journal of Sustainability in Higher Education. Tufts University Alliance for the
Prudent Use of Antibiotics. 2001;2(3):288–289.
Spellberg B, Bartlett J, Glibert D. 2013 Jan 24. The Future of Antibiotics and Resistance. New England Journal of Medicine. 368(4): 299–302.
The cost of antibiotic resistance to U.S. families and the healthcare system. Tufts University; 2010 Sep.
U.S Government. 2008. The Importance of Health and Health Care. In: U.S GPO. Economic
Report of the President: U.S. Government Publishing Office. P. 97–144.
World Bank. 20 September 2016. By 2050, drug-resistant infections could cause global economic damage on par with 2008 financial crisis. IBRD. https://tinyurl.com/yaeymtpz