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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background: Ambulatory 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. Methods: In 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. Results: The 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. Conclusions: Each 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.

Original languageEnglish (US)
Article number655
JournalBMC Infectious Diseases
Volume16
Issue number1
DOIs
StatePublished - Nov 8 2016

Keywords

  • Antibiotic resistance
  • Negative externality
  • Primary care
  • Societal costs
  • Stewardship

ASJC Scopus subject areas

  • Infectious Diseases

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