OBJECTIVES: Antimicrobial resistance (AMR) is a rapidly escalating, highly complex global health and economic problem. Economic evaluation (EE) of policies tackling AMR is complicated by the multisectoral, inter-temporal and international aspects of the problem that result in diffuse effects of the interventions. We reviewed the effects of anti-AMR interventions quantified and the methods used to derive these in the available EE literature.

METHODS: A systematic literature review is being conducted by Ananthakrishnan et al (in preparation) that included EE of anti-AMR policies published in 2000 - 2020. We extracted further detail on the (i) measures used to quantify AMR, health effects and costs; (ii) methods used to derive AMR effects; (iii) methods used to link AMR effects with health effects and costs. The literature was presented with evidence gap maps based on World Health Organisation (WHO) AMR Global Action Plan (GAP) objectives summarising (i) scope and perspective of the studies, (ii) measures and methods used in the EE.

RESULTS: 32 publications were included (pending final review from Ananthakrishnan et al). 15/32 and 22/32 studies evaluated interventions that aimed to reduce infection rates and optimise antimicrobial use, respectively (WHO GAP objectives). 31/32 of the EE were conducted with a high and/or upper-middle income country perspective, 31/32 were on interventions addressing human health. 25/32 were full EE with 15/25 – cost-utility analyses. 6/32 and 25/32 studies quantified only surrogate and full AMR effects, respectively. 13/32, 10/32 and 7/32 studies estimated the AMR effects through direct estimation from the data, decision tree and/or Markov models and transmission models, respectively. Transmission models and cost-utility analyses were more commonly used to evaluate interventions aimed at reducing infection rates.

CONCLUSIONS: There is insufficient EE literature on anti-AMR interventions, and there are important gaps in the topics covered and the extent of the analyses conducted.