Societal Economic Burden of Antibiotic Resistance in Uganda: A Cost of Illness Study.

backgroundAntibiotic resistance (ABR), largely owing to inappropriate prescriptions and misuse of antibiotics, threatens the effectiveness of current and future antibiotic treatments, resulting in prolonged hospitalization and premature mortality. We estimated the economic burden of ABR in nine regional referral hospitals (RRHs) in Uganda.

methodsThis prevalence-based cost-of-illness study was conducted from the societal perspective. We used a top-down micro-costing approach to identify and measure direct healthcare (capital and recurrent) costs in nine RRHs in Uganda. Patient costs, including informal care (absenteeism, foregone leisure, presenteeism, and out-of-pocket expenses), and lost productivity owing to ABR were estimated using clinical outcomes data and relevant literature. We used the human capital approach to estimate productivity losses due to ABR-related morbidity and premature mortality. A one-way sensitivity analysis was conducted to assess the impact of individual parameters on the economic burden estimates.

resultsThe annual societal cost of ABR in nine RRHs was estimated at US$1.43 million, representing 0.003% of Uganda's gross domestic product. Lost productivity costs accounted for 82% of the total, while informal care and direct healthcare costs represented 10% and 8%, respectively. Premature mortality associated with ABR accounted for 62% of the total cost of productivity loss; accommodation, food, and out-of-pocket costs represented 55% of the informal care costs; and recurrent costs accounted for 89% of direct healthcare costs. The overall annual societal, health system, and patient costs per ABR-patient were US$4983, US$423, and US$4560, respectively. ABR health system costs were 3% higher (US$61,293 versus US$59,646) among females than among males. Patient costs associated with ABR were higher among females than males, with informal care costs being 4% higher (US$70,657 versus US$67,886), and lost productivity costs 34% higher (US$622,510 versus US$410,354). Overall, societal total costs and per-patient costs of ABR were 29% (US$754,461 versus US$537,886) and 21% (US$5063 versus US$4014) higher in females than in males, respectively. The one-way sensitivity analysis revealed that the societal economic burden of ABR estimates were most influenced by uncertainties in construction cost per square meter of space utilized by ABR patients, reduced hospital capacity, and the discount rate.

conclusionsABR poses a substantial societal burden that necessitates urgent and targeted gender-based interventions to prevent its escalation. These estimates may be used for future economic evaluation studies of ABR-mitigating interventions and to inform antimicrobial stewardship policies.