OBJECTIVES

To examine the impact of antimicrobial resistance (AMR) on pediatric pneumococcal infections in Ethiopia.

METHODS

We developed an agent-based model – DREAMR (Dynamic Representation of the Economics of AMR) – to assess the health and economic burden of AMR on antibiotics to treat pneumococcal diseases in Ethiopia. The model simulated children under age five with pneumococcal pneumonia, meningitis, or acute otitis media, where infected children sought care at varying health facilities and utilized antibiotic treatment. Pharmacokinetics and pharmacodynamics methods were used to determine whether bacteria died under antibiotic exposure. Dynamic resistance levels of three antibiotics (i.e., penicillin, amoxicillin, and ceftriaxone) were modeled. The cost-of-illness approach was employed to assess the burden (e.g., treatment failures, deaths, disabilities) attributable to AMR. We evaluated the economic burden that included direct and indirect medical costs, productivity losses for caretakers, and productivity losses due to premature deaths and disabilities.

RESULTS

Preliminary results suggested that AMR led to treatment failures in almost 30% (95% CI: 25.2 – 33.6%) of first-line antibiotic therapy for pediatric pneumococcal diseases. In one year, resistance against Streptococcus pneumoniae increased by 0.5% (-0.4 – 1.3%) for amoxicillin and 0.8% (-0.1 – 1.8%) for penicillin, and reduced by 0.3% (-0.7 – 0.1%) for ceftriaxone. AMR against pneumococcal diseases contributed to around 270,000 (214,574 – 321,862) treatment failures and 1,300 (0 – 5,960) deaths. Treatment costs of AMR related pneumococcal infections were approximately $14 million ($7,130,000 – $39,522,000) annually, including $4 million ($3,087,000 – $5,273,000) for ineffective first-line treatments and $10 million ($4,043,000 – $34,249,000) for additional second-line treatments.

CONCLUSIONS

This is the first study to develop an agent-based model to estimate the impact of AMR on treatment of pediatric pneumococcal infections in Ethiopia. Reducing misuse and overuse of antibiotics is essential to maintain the effectiveness of antibiotics and lessen the health and economic burden of AMR.