BEYOND BACTERIA: THE OVERLOOKED MACROECONOMIC BURDEN OF FUNGAL INFECTIONS
Author(s)
Marco Hafner1, Alessandro Grosso, MsC2, David Denning, Professor3, Malcolm Bain, PhD4.
1Principal Health Economist, Rand Europe, Cambridge, United Kingdom, 2RAND Europe, The Hague, Netherlands, 3University of Manchester, Manchester, United Kingdom, 4SHIONOGI B.V., Helensburgh, United Kingdom.
1Principal Health Economist, Rand Europe, Cambridge, United Kingdom, 2RAND Europe, The Hague, Netherlands, 3University of Manchester, Manchester, United Kingdom, 4SHIONOGI B.V., Helensburgh, United Kingdom.
OBJECTIVES: Macroeconomic assessments of antimicrobial resistance (AMR) have focused almost exclusively on bacterial pathogens, leaving the economic burden of fungal infections largely unquantified. This gap is increasingly consequential as fungal pathogens pose a growing threat driven by expanding at-risk populations, limited diagnostic capacity, and emerging resistance to antifungal therapies. We present the first global assessment of the current and projected macroeconomic burden of fungal infections.
METHODS: We link a multi-region dynamic computable general equilibrium model to a population-based cohort-component demographic module to estimate the economic impact across countries and regions. The analysis covers clinically significant diseases caused by WHO priority fungal pathogens: invasive aspergillosis, chronic pulmonary aspergillosis, candidaemia, invasive candidiasis, cryptococcal meningitis and mucormycosis. Structured scenario analyses quantify both the cost of inaction under alternative resistance trajectories and the potential economic value of antifungal interventions. To address parameter uncertainty, burden estimates are reported as ranges based on sensitivity analyses.
RESULTS: In 2025, an estimated 2.9-7.1 million people globally were affected by a modelled fungal disease, with 1.6-5.2 million attributable deaths; undiagnosed and untreated cases accounted for 65-83% of these. By 2050, fungal diseases are projected to reduce the global population by 45.7-146.6 million people, including 29.9-94.8 million of working age. Resistance alone accounts for 0.5-1.7 million of this reduction under current trajectories, rising to 0.8-4.8 million under a high-resistance scenario (gradual increase to 40% resistance by 2050). These losses imply a non-trivial contraction in global labour supply and a substantial reduction in economic output.
CONCLUSIONS: Fungal infections and rising antifungal resistance constitute a substantial and growing macroeconomic risk. These findings establish the economic rationale for greater investment in antifungal innovation and surveillance.
METHODS: We link a multi-region dynamic computable general equilibrium model to a population-based cohort-component demographic module to estimate the economic impact across countries and regions. The analysis covers clinically significant diseases caused by WHO priority fungal pathogens: invasive aspergillosis, chronic pulmonary aspergillosis, candidaemia, invasive candidiasis, cryptococcal meningitis and mucormycosis. Structured scenario analyses quantify both the cost of inaction under alternative resistance trajectories and the potential economic value of antifungal interventions. To address parameter uncertainty, burden estimates are reported as ranges based on sensitivity analyses.
RESULTS: In 2025, an estimated 2.9-7.1 million people globally were affected by a modelled fungal disease, with 1.6-5.2 million attributable deaths; undiagnosed and untreated cases accounted for 65-83% of these. By 2050, fungal diseases are projected to reduce the global population by 45.7-146.6 million people, including 29.9-94.8 million of working age. Resistance alone accounts for 0.5-1.7 million of this reduction under current trajectories, rising to 0.8-4.8 million under a high-resistance scenario (gradual increase to 40% resistance by 2050). These losses imply a non-trivial contraction in global labour supply and a substantial reduction in economic output.
CONCLUSIONS: Fungal infections and rising antifungal resistance constitute a substantial and growing macroeconomic risk. These findings establish the economic rationale for greater investment in antifungal innovation and surveillance.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE342
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Novel & Social Elements of Value
Disease
Infectious Disease (non-vaccine), Oncology, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)