Antimicrobial resistance (AMR) ranks among the top ten global public health challenges.¹ Partly driven by the inappropriate and injudicious use of antimicrobial agents, AMR poses a significant threat. In 2019, nearly 5m global deaths were linked to AMR, with 1.3m directly attributable to it.² If this trend continues, AMR could be responsible for an estimated 10m annual deaths worldwide by 2050.³

Accurate estimation of the disease and cost impacts of AMR is crucial for developing effective strategies and interventions. However, the complexity of AMR and insufficient national surveillance data affect the accuracy of these estimates. To tackle this, the World Health Organisation (WHO) initiated the Global Antimicrobial Resistance and Use Surveillance System (GLASS) to enhance surveillance, improve data collection, and provide technical support to countries.⁴ Despite these efforts, there is still a lack of high-quality patient-level resistance data linked to clinical outcomes. Furthermore, while the WHO Global Action Plan on AMR emphasises the need for economic models, progress in this area has been limited.⁵

“Tackling antimicrobial resistance in healthcare: the significance of robust health and economic data” is a report produced by Economist Impact and supported by Pfizer. In this report, we have estimated the burden of AMR in hospital acquired infections (HAIs) in six emerging countries: Brazil, Mexico, Egypt, Saudi Arabia, India and China. Using a bespoke modelling framework, the research estimates the direct costs to health systems due to HAIs caused by selected resistant bacteria in 2019.

The research focuses on how to improve the accuracy of economic burden estimates and use them to bolster the response to AMR. The report presents the following key findings:

Improving economic estimates requires:

• Stronger surveillance: Key to improving estimates of the economic burden of AMR is strengthening active surveillance of drug-resistant infections and generating high-quality data. Harnessing digital technologies will improve surveillance by overcoming the challenges inherent in fragmented health systems and workforce constraints. Ensuring compatibility between local, national and international IT systems for AMR surveillance will improve reporting and transparency.
• Simplified case definitions for HAIs: Collecting data on HAIs can be challenging in low-resource settings due to complex definitions that require detailed clinical documentation and laboratory support. Standardising these definitions across emerging countries, particularly those with limited resources, can enhance HAI reporting and improve the reliability of estimates.
• Better cost tracking: Quantifying the economic burden of AMR is a huge undertaking. Various direct and indirect costs need to be considered, given the multidimensionality of the problem. Important direct costs include those relating to hospitalisation, testing and treatment. A simple starting point could be to improve estimates of the cost of antimicrobials used in resistant HAIs through better documentation and tracking of antimicrobial consumption.

More accurate economic burden estimates can be leveraged to:

• Create awareness: Reliable cost estimates of AMR can significantly raise awareness among the public, hospital administrators, and policymakers. A message of how resources wasted via misuse of antibiotics can be redirected to improved healthcare provision can be powerful in galvanising action. Understanding the cost implications of AMR can also encourage hospitals to provide better AMR-control training for healthcare professionals.
• Assess cost-effectiveness of AMR interventions: With improved estimates of the financial implications, cost savings of interventions used to control AMR, including stewardship programmes, can be measured more accurately. These savings can be used for ring-fenced budgets in a milieu where resources are stretched.
• Use of ring-fenced budgets to tackle AMR: Additional resources secured through ring-fenced budgets can be used to roll out financial incentives to hospitals for ensuring rational antimicrobial usage, establishing better surveillance systems, improving laboratory and IT infrastructure, and ensuring good sanitation. These measures will ensure that patients have access to the right antibiotics at the right time, improving health outcomes.