Measuring the Externality of Antibacterial Use from Promoting Antimicrobial Resistance

Background: The emergence and spread of antimicrobial resistance (AMR) has become a serious public health threat. Rational antibacterial policy, combined with enforcement of infection control practices are key strategies to combat AMR in the hospital setting. Loss of antibacterial activity as a direct result of antibacterial consumption can be modelled via the economic approach of a negative externality. Objective: To determine the externalities of antibacterial consumption and alcohol-based hand rub use for hand disinfection. Methods: A simple model was built, combining the results of a recently conducted cost-of-illness study with the results of a multivariate time-series analysis, which determined the impact of antibacterial consumption and alcohol-based hand rub use on the incidence of hospital-acquired infections caused by meticillin-resistant Staphylococcus aureus (MRSA). Results: Consumption of a single defined daily dose of second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones and lincosamides is associated with a negative externality of about &U20AC;5, &U20AC;15, &U20AC;11 and &U20AC;12, respectively. In contrast, use of 1 litre of alcohol-based hand rub solution for hand disinfection is associated with a positive externality of about &U20AC;61. In other words, a single disinfection of the hands (use of 3 mL alcohol-based hand rub solution) saves an average &U20AC;0.18 of the potential cost incurred by MRSA-related infections. Conclusions: Quantifying the externalities of antibacterial use and alcohol-based hand rub use may lead to changes in prescribing behaviour and increase compliance with hand disinfection. Furthermore, the presented methodology of relating the cost of resistance to specific factors such as antibacterial use and hand disinfection provides information that may be useful for prioritizing prevention methods.