OBJECTIVES: Antimicrobial resistance (AMR) is an urgent threat that impacts the ability to prevent and treat infections. Often, an economic case is required for adequate investment in AMR programs such as infection prevention and antimicrobial stewardship. This review aims to evaluate methodologies used to assess the economic burden of AMR and summarizes the published cost data.

METHODS: A targeted literature review on the economic burden of AMR was conducted in PubMed (2014-2018); relevant peer-reviewed, English language articles were included. Cost estimates were converted to 2018 US dollars.

RESULTS: The targeted search yielded 24 relevant articles for final inclusion. These articles evaluated the economic impact of resistance in Acinetobacter, Enterobacteriaceae, Enterococcus, Pseudomonas, Staphylococcus, Streptococcus, and resistant infections, more broadly. Data originated from 15 different countries worldwide and examined costs from patient, payer, provider, and societal perspectives. The majority of articles (12/15) determined that resistance had a statistically significant impact on direct healthcare costs when compared to susceptible infections. However, the estimated costs of AMR had considerable variation due to heterogeneity in definitions, study populations, care settings, cost data, and methodology (e.g. matched case-control, multi-state modeling, regression analysis, etc.). Per case healthcare costs for patients with methicillin-resistant Staphylococcus aureus ranged from $2,733-290,483, resistant Acinetobacter ranged from $4,003-37,414, and carbapenem-resistant Enterobacteriaceae ranged from $11,361-39,291. At current rates of resistance, economic modelling estimates that AMR could cost the global economy over $500 billion per year by 2050.

CONCLUSIONS: This review highlights AMR as a micro- and macro-economic burden impacting patients and healthcare systems across the world. Infection prevention and antimicrobial stewardship have been broadly recognized as strategies to control the burden of AMR. Tools to assess the economic burden of AMR could be valuable for countries, health care systems and facilities to prioritize these efforts to reduce AMR.