Infection Control & Hospital Epidemiology (2019), 40,320–327 doi:10.1017/ice.2019.2
Original Article
Health and economic burden of antimicrobial-resistant infections in Australian hospitals: a population-based model Teresa M. Wozniak PhD1,2
, Emily J. Bailey MBA2 and Nicholas Graves PhD2
1Menzies School of Health Research, Royal Darwin Hospital, Rocklands Drive, Tiwi, Darwin, Northern Territory, 0810, Australia and 2Centre for Research Excellence, Reducing Healthcare-Associated Infections, Australian Centre for Health Services Innovation, Queensland University of Technology, Queensland, Australia
Abstract Objective: To estimate the additional health and economic burden of antimicrobial-resistant (AMR) infections in Australian hospitals.
Methods: A simulation model based on existing evidence was developed to assess the additional mortality and costs of healthcare-associated AMR Escherichia coli (E. coli), Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecium, and Staphylococcus aureus infections.
Setting: Australian public hospitals.
Findings: Australian hospitals spent an additional AUD$5.8 million (95% uncertainty interval [UI], $2.2–$11.2 million) per year treating ceftriaxone-resistant
E.coli bloodstream infections (BSI), and an estimated AUD$5.5 million per year (95% UI, $339,633–$22.7 million) treat- ingMRSApatients. There are no reliable estimates of excess morbidity and mortality fromAMRinfections in sites other than the blood and in particular for highly prevalent AMR E. coli causing urinary tract infections (UTIs).
Conclusion: The limited evidence-base of the health impact of resistant infection in UTIs limits economic studies estimating the overall burden of AMR. Such data are increasingly important and are urgently needed to support local clinical practice as well as national and global efforts to curb the spread of AMR.
(Received 14 September 2018; accepted 21 December 2018)
World leaders gathered at theUnitedNationsGeneralAssembly and called for country-level strategies and implementations plans to reduce antimicrobial resistance (AMR)worldwide.1Many countries, including Australia have a nationalAMR strategy and implementa- tion plan already in place,2 but the evidence showing the health and economic burden of these infections on the population is limited.3 The current evidence of the cost of AMR infections to human
health is highly variable.4 Healthcare costs can be quantified several ways with a range of economic perspectives used. One method is to measure the prolongation of length of hospital stay (LoS) and extra mortality risk associated with AMR infections.5,6 Many studies have reported the costs of AMR infections in the past decade,7 and these have produced highly variable estimates ranging from US$10.7–15 million across all AMR organisms8 to £3–11 billion for MRSA only9 or a global economic output of US$100 trillion by 2050.10 The methods used to generate these estimates vary and should be carefully considered prior to new policy being implemented to reduce the problem.11 We aimed to provide Australian estimates of the cost of five
clinically important hospital-associated infections using local data and transparent methods. Estimating the economic burden is
Author for correspondence: Teresa M. Wozniak, Email: teresa.wozniak@menzies.
edu.au Cite this article: Wozniak TM, et al. (2019). Health and economic burden of
antimicrobial-resistant infections in Australian hospitals: a population-based model. Infection Control&Hospital Epidemiology, 40: 320–327,
https://doi.org/10.1017/ice.2019.2
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
useful to prioritize infection control programs and health policies and to support Australian and global AMR efforts.
Methods Ethics
The Health and Economic Modelling of Antimicrobial Resistance in Australia (HEMAA) project meets the conditions within section 5.1.22 of the Australian National Statement on Ethical Conduct in Human Research (2007) for exemption from Human Research Ethics Committee review and approval, and an exemption was granted accordingly by the Queensland University of Technology (QUT) University Human Research Ethics Committee. Written approval was provided for the release of data from Queensland Department of Health, Pathology Queensland, pertaining to the organism, site of infection and antibiotic susceptibility testing.
Building the economic model
The economic model was developed with input parameters for each combination of bacteria and resistance profiles (Fig. 1 andTables 1–5). Weestimatedthenumber of resistantandsusceptible infectionsfrom Queensland Department of Health, Pathology Queensland database for the year 2014. A synthesis of published literature informed the estimates of excess LoS, value of a bed day, antibiotic treatment, and excess risk of death. The cost of a single infection was a product of excess cost for antibiotic treatment plus excess length of hospital
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