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Towards a full picture of the costs of antimicrobial resistance

A first attempt to quantify the hidden cost of in-hospital adjustment reactions in a changing environment of resistance

Funding: DFG - German Research Council (DFG KA 4199/1-1)
Project duration: 36 months
Project leader: Klaus Kaier
Collaborators: Thomas Heister

The emergence and spread of antimicrobial resistance (AMR) is still an unresolved problem worldwide. The major direct effect of AMR, healthcare-associated infections (HAIs) are considered to be the most frequent adverse event in health care delivery. HAIs caused by multidrug-resistant bacteria impose a substantial financial burden on the healthcare system through exacerbation or prolongation of illness and subsequent in-hospital treatment. This direct medical and financial burden of AMR was described in a huge basket of empirical studies. Basically, nearly any of these studies is focussing on the medical and/or economic burden of patients facing infections. The emergence and spread of AMR, however, does not lead to an increase in the number of HAIs only. AMR also impacts patients who do not become infected. Generally spoken, infectious diseases are communicable and the fear of transmission or infection leads patients and physicians to alter their behaviour. As in-hospital resistance patterns change over time, rationale weighting induces decision-makers to adjust their behaviour in order to provide the best possible treatment in a changing environment of resistance. Such adjustment reactions may be seen as prophylactic measures to avoid the adverse events of HAIs. In settings where resistant organisms are prevalent, for instance, physicians routinely change empirical antibiotic therapy in accordance to the relevant resistance indicator leading to differences in costs, dosing schedules and/or side-effect profiles. With respect to the available literature, resistance-induced adjustment reactions were often postulated as having a major influence on modern health care delivery, but rarely addressed in empirical works.

The general aim of the project is to identify and apply methods for quantifying the hidden cost of resistance in the hospital setting. Appropriate data sources and statistical approaches will be identified enabling to show the impact of resistance on specific clinical adjustment reactions and allow quantifying this relationship in order to determine the hidden cost of resistance. These methods will be applicable to three specific scenarios of resistance-induced adjustment reactions in the clinical setting. Moreover, a maximum level of transferability of results for further research synthesis will be warranted.

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Heister, T., C. Hagist and K. Kaier (2015): Resistance Elasticity of Antibiotic Demand in Intensive Care , WHU - Working Paper Series in Economics 15/01.