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Toolbox  –  Measure

Burden of antibiotic resistance

Data on the burden of antibiotic resistance is important for understanding the magnitude of the problem and for communicating the urgency to address the topic.

Potential indicators of burden

Humans:

  • Excess mortality or morbidity
  • Excess hospital, healthcare provider or payer costs
  • Economic impact (change in Gross Domestic Product)

Animals:

  • Farm productivity or yield
  • Farm costs, income or profit
  • Economic impact (change in Gross Domestic Product)

Mapping the global burden of resistance

The Global Burden of Disease is a global research program that provides a tool to quantify health loss from different diseases, injuries, and risk factors. It covers both the prevalence of a given disease or risk factor and the relative harm it causes. Data is collected and analyzed by a consortium of more than 3,600 researchers in over 145 countries. There is data from 1990 to the present, across different age groups and populations.

Work is now ongoing to include mortality and morbidity data related to resistant infections into the Global Burden of Disease Study. The initial phase will focus on synthesizing existing data and developing analytical methods to estimate the fraction of burden that is attributable to resistance. Disease burden estimates will be produced and incorporated into publicly accessible visualizations and maps.

Potential long term consequences of antibiotic resistance

When estimating the burden of resistance or the impact of related policies, it is important to consider the potential long term consequences of antibiotic resistance. The flowchart below depicts the potential long term burden of resistance if no interventions or new antibiotics were added to the system.

The cost of inaction. Flowchart of potential consequences unless action is taken against antibiotic resistance.

The burden of antibiotic resistance is closely linked to the overall occurrence of bacterial infections. For information on measuring infections, see MEASURE – Infections.

Selected Resources

Tools and methodology

Resources Description
Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis Journal article with methodology from ECDC reporting on the burden of antibiotic resistance in EU/EEA. It also includes estimates of morbidity in DALYs. 
LiST: The Lives Saved Tool Tool: The Lives Saved Tool (LiST) is a PC tool that estimates the impact of scaling up health and nutrition interventions on maternal, newborn, and child health.
Estimating the burden of antimicrobial resistance: a systematic literature review Review with recommendations discussing alternative methodologies for estimating the burden of antibiotic resistance in the current evidence base.
Economic analysis of animal diseases Guidelines on how to conduct analysis on economic impact of animal diseases (but not specifically on antibiotic resistance).

Data and reports

Resources Description
When the Drugs Don’t Work – Antibiotic Resistance as a Global Development Problem (PDF 6,1MB) Report from ReAct that describes the negative impact of antibiotic resistance on global and national efforts to eradicate poverty, spur economic growth, reduce inequality, improve global public health, reduce hunger and protect the environment (Sustainable development goals 1, 2, 3, 5, 6, 8, 10, 12, 14 and 15).
Antimicrobial resistance: global report on surveillance 2014 Report: Section 3 of this WHO surveillance report (page 34-41) examines the available evidence worldwide of the health and economic burden of antibiotic resistance in 3 bacteria.
Drug-resistant infections: A Threat to our Economic Future, 2017 Report: This World Bank report estimates the potential burden of antimicrobial resistance by 2050. See “Part II. Economic Impact of AMR” for estimates of the burden of antibiotic resistance on health and agricultural sectors in low-income countries.
Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis Review: This literature review collates studies estimating the health and cost burden of antibiotic resistance in developing countries.
Antibiotic resistance threats in the United States, 2013 Report that gives a snapshot of the burden and threats in the US posed by the antibiotic resistant bacteria having the most impact on human health. Specifies types of bacteria and to what antibiotics resistance is a problem.
Antibiotic resistance – consequences for animal health, welfare, and food production Review: This article describes the negative effects of antibiotic resistance on animal health, animal welfare and different socio-economic consequences if infectious diseases in animals cannot be treated.
Health and Economic Impacts of Antimicrobial Resistant Infections in Thailand: A Preliminary Study Journal article: This study assessed health and economic impacts of antimicrobial resistance in Thailand under societal perspective by using the secondary data on hospitalizations and nosocomial infections from 1,023 hospitals (abstract in available in English, article in Thai).
Access to effective antimicrobials: a worldwide challenge Journal article: This study assesses the global disease burden caused by limited access to antimicrobials, attributable to resistance to antimicrobials, and the potential effect of vaccines in restricting the need for antibiotics.
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McLeod A, Pinto J, Lubroth J, Martin V, Rushton J, Food and Agriculture Organization of the United Nations. Economic analysis of animal diseases. [Internet]. 2016. Available from: http://www.fao.org/ag/againfo/home/en/news_archive/2016_Economic_analysis_animal_diseases.html
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ReAct - Action on antibiotic resistance. When the Drugs Don’t Work - Antibiotic Resistance as a Global Development Problem [Internet]. 2019. Available from: https://www.reactgroup.org/wp-content/uploads/2019/02/When-the-Drugs-Don%E2%80%99t-Work-Antibiotic-Resistance-as-a-Global-Development-Problem-Feb-2019.pdf
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World Bank. Drug Resistant Infections: A Threat to Our Economic Future [Internet]. Washington (DC), U.S.A.; 2017. Available from: http://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future
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Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen J-A, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. Lancet. 2016 Jan 9;387(10014):168–75.
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Phumart P, Phodha T, Thamlikitkul V, Riewpaiboon A, Prakongsai P, Limwattananon S. Health and Economic Impacts of Antimicrobial Resistant Infections in Thailand : A Preliminary Study. Journal of Health Systems Research [Internet]. 2012 Sep;6(3):352–60. Available from: http://kb.hsri.or.th/dspace/handle/11228/3699