Evidence map›Paper›PMID 27825306›Full record

ArticleBMC infectious diseases2016

The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.

Constantinos I Michaelidis, Michael J Fine, Chyongchiou Jeng Lin, Jeffrey A Linder, Mary Patricia Nowalk, Ryan K Shields, Richard K Zimmerman, Kenneth J Smith

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC infectious diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03674775 (Dialogue Around Respiratory Illness Treatment for Family Practice), which is not on this map. Cited by 25 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03674775 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Dialogue Around Respiratory Illness Treatment for Family Practice (DART -FP)

TypeinterventionalSponsorSeattle Children's HospitalRan2022 to 2026Enrolled180ConditionsAcute Respiratory Tract InfectionArmsDART QI Program Participation
3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Trial
  6. Article
  7. Review
  8. Article
  9. Article
  10. Article
  11. Vaccination to Reduce Antimicrobial Resistance Burden-Data Gaps and Future Research.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023
    Article
  12. Article
  13. Review
  14. Article
  15. Review
  16. Article
  17. Article
  18. Review
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Constantinos I MichaelidisDivision of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. cmichaelidis@partners.org.
Michael J FineDivision of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Chyongchiou Jeng LinDepartment of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Jeffrey A LinderDivision of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Mary Patricia NowalkDepartment of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ryan K ShieldsDivision of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Richard K ZimmermanDepartment of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Kenneth J SmithDivision of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Funding

Use of Behavioral Economics to Improve Treatment of Acute Respiratory InfectionsRC4AG039115 · NIA · UNIVERSITY OF SOUTHERN CALIFORNIA · PI DOCTOR, JASON N. · 2010 to 2010
$11.5M
University of Pittsburgh Clinical and Translational Science InstitutionKL2TR000146 · NCATS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI REIS, STEVEN E · 2012 to 2015
$8.7M
Pitt Integrated Clinical and Geroscience Research Training ProgramT32AG021885 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI Aditi U Gurkar · 2003 to 2026
$6.7M
Demonstration of Near Zero Antibiotic Prescribing for Acute BronchitisR18HS018419 · AHRQ · BRIGHAM AND WOMEN'S HOSPITAL · PI LINDER, JEFFREY A. · 2010 to 2013
$1.2M
Alternative Strategies for Adult Pneumococcal VaccinationR01AI076256 · NIAID · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI SMITH, KENNETH J · 2008 to 2011
$902k
Caspofungin pharmacokinetics-pharmacodynamics during intra-adbominal candidiasisK08AI114883 · NIAID · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI SHIELDS, RYAN K · 2015 to 2019
$858k
Antibiotic Prescribing for Acute Respiratory Infections: Impact of Shifts in CareR21AI097759 · NIAID · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI MEHROTRA, ATEEV · 2012 to 2013
$560k
AHRQ HHS R18 HS018419NCATS NIH HHS KL2 TR000146NIAID NIH HHS K08 AI114883NIAID NIH HHS R01 AI076256NIAID NIH HHS R21 AI097759NIA NIH HHS RC4 AG039115NIA NIH HHS T32 AG021885
6 · The paper itself

Abstract

backgroundAmbulatory antibiotic prescribing contributes to the development of antibiotic resistance and increases societal costs. Here, we estimate the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States.

methodsIn an exploratory analysis, we used published data to develop point and range estimates for the hidden societal cost of antibiotic resistance (SCAR) attributable to each ambulatory antibiotic prescription in the United States. We developed four estimation methods that focused on the antibiotic-resistance attributable costs of hospitalization, second-line inpatient antibiotic use, second-line outpatient antibiotic use, and antibiotic stewardship, then summed the estimates across all methods.

resultsThe total SCAR attributable to each ambulatory antibiotic prescription was estimated to be $13 (range: $3-$95). The greatest contributor to the total SCAR was the cost of hospitalization ($9; 69 % of the total SCAR). The costs of second-line inpatient antibiotic use ($1; 8 % of the total SCAR), second-line outpatient antibiotic use ($2; 15 % of the total SCAR) and antibiotic stewardship ($1; 8 %). This apperars to be an error.; of the total SCAR) were modest contributors to the total SCAR. Assuming an average antibiotic cost of $20, the total SCAR attributable to each ambulatory antibiotic prescription would increase antibiotic costs by 65 % (range: 15-475 %) if incorporated into antibiotic costs paid by patients or payers.

conclusionsEach ambulatory antibiotic prescription is associated with a hidden SCAR that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.

Indexed as

Anti-Bacterial AgentsCosts and Cost AnalysisDrug Resistance, MicrobialHospitalizationHumansUnited StatesAnti-Bacterial AgentsAntibiotic resistanceNegative externalityPrimary careSocietal costsStewardship

Identifiers

PMID27825306
PMCPMC5101711

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.