Mike the Mad Biologist

The Economic Burden of Antibiotic Resistance

It’s between fifteen to twenty one cents of every dollar spent by hospitals. A recent study examined the costs of antibiotic resistant infections in hospitals. The main finding (italics mine):

The total attributable hospital and societal cost ranges for ARI in the expanded sample were as follows: hospital, $3.4-$5.4 million; mortality, $7.0-$9.2 million; lost productivity, $162,624-$322,707; and total, $10.7-$15.0 million. The total medical cost, if distributed to all sample patients, added $2512-$3929 (16.8%-26.3%) to the mean unadjusted hospital cost for all sample patients.

(An aside: The last sentence describes the additional cost, not the percentage of hospital bills)

What’s even more disturbing is that for every additional–that is, unnecessary–dollar spent in the hospital, we spend two dollars as a society on things; this was calculated by calculating the loss of productivity due to deaths and due to additional days in the hospital (this is probably an underestimate).

One thing to make clear: in this study, the cost of antibiotic resistance does not include hospital-acquired infections. These were excluded (and are more expensive to treat according to the study). This study only examines the cost of an ‘ordinary’ infection that happens to be resistant.

Some other fun facts:

•the economic cost of an antibiotic resistant infection per case was between $18,588-$21,208 (patients without a resistant infection averaged ~$13,000 to put this in perspective)

•the mortality rate for patients with resistant infections was double that of patients without resistant infections (after confounding variables were removed)

•MRSA infections add an average of $10,732 to a hospital bill (after confounding effects are controlled)

•VRE (vancomycin resistant enterococci) add an average of $24,080 to a hospital bill (after confounding effects are controlled)

•Floroquinolone-resistant E. coli and Klebsiella (including ciprofloxacin–”Cipro”–resistant) add an average of $2,679 to a hospital bill (after confounding effects are controlled). They’re cheap!

•Amikacin or imipenem resistant infections add an average of $40,003 to a hospital bill (after confounding effects are controlled)

•And the mother of all infections–that is, having more than one resistant infection–adds an average of $108,413 to a hospital bill (after confounding effects are controlled)

There are a bunch of caveats: this was one hospital in one year. On the other hand, the societal costs are probably underestimated. Nonetheless, this is a huge burden. Five to ten amikacin or imipenem resistant infections can pretty much wipe out the budget for any number of preventative health problems, such as prenatal care outreach, nutritional consulting, and neonatal care programs.

While the deaths caused by antibiotic resistant infection are the greatest tragedy, the economic burden is also a silent killer.

Cited article: Rebecca R. Roberts, Bala Hota, Ibrar Ahmad, R. Douglas Scott II, Susan D. Foster, Fauzia Abbasi, Shari Schabowski, Linda M. Kampe, Ginevra G. Ciavarella, Mark Supino, Jeremy Naples, Ralph Cordell, Stuart B. Levy, and Robert A. Weinstein. 2009. Hospital and Societal Costs of Antimicrobial‐Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship. Clinical Infectious Diseases 49: 1175-1184.

Comments

  1. #1 addie
    December 3, 2009

    These superbugs come from factory farming and their overuse of antibiotics. Thanks for the post. But let’s go back to the source too.

  2. #2 TonyP
    December 3, 2009

    These superbugs come from factory farming and their overuse of antibiotics.

    I was expecting to see a comment along those lines in the post. Is there any scientific research that attempts to find out to what degree the rise of antibiotic-resistant infections is due to use of antibiotics for non-medicinal purposes in animal farming, vs medical use of antibiotics in humans?

  3. #3 addie
    December 3, 2009

    What’s with the impatient tone, TonyP? There’s lots of research. LOTS. Maybe look around before sighing so audibly: i.e. Johns Hopkins is leading the research on the link.
    Here’s a recent quote from their Magazine:

    Johns Hopkins researchers are investigating a troubling potential source of resistant pathogens: the American farm.

    Millions of animals on antibiotics…. Millions. And the antibiotics are getting into the soil and therefore vegetables too.

  4. #4 addie
    December 3, 2009

    Me again. Here’s a paragraph from the Johns Hopkins report:In his 1945 Nobel Prize address, Alexander Fleming warned that it was easy to produce microbes resistant to his discovery, penicillin: Simply expose them to concentrations of the drug insufficient to kill them. Possibly the first warning that antibiotics could produce drug-resistant pathogens in poultry came as far back as 1951, when two bacteriologists at the University of California, Davis named Mortimer P. Starr and Donald M. Reynolds published a paper that noted in its summary: “The use of streptomycin as a growth-promoting supplement in turkey poults results in the appearance within three days of streptomycin-resistant coliform bacteria.” But little apparent attention was paid to Starr and Reynolds, or to Fleming. During ensuing decades, tens of millions of pounds of tetracycline, penicillin, and other antibiotics were fed to animals on American and European farms. In some cases, the drugs were used to treat sick animals, in amounts that killed the bacteria. But most were fed to cattle, pigs, turkeys, and chickens in exactly the subtherapeutic dosages that Fleming warned would only make bacteria stronger.

  5. #5 tmullins
    December 4, 2009

    I’ve tried for almost six years to get answers to questions concerning the rise of MRSA/VRE from everyone from the local level to the state level and even my congressman about my concerns of hospital acquired infections breeding and being dumped into our communities and no one has any authority to do anything in Virginia or Tennessee. How many more innocent people have to die ? This should not be in our schools and communities but no one who can do anything seems to care.

    http://www.wisecountyissues.com/?p=62

    My father got his MRSA/VRE in hospital and in Virginia and Tennessee is perfectly within the parameters of what is deemed, defended and supported as “the acceptable standards of health care”. Clearly profit care is more important than patient care in America.

  6. #6 Queef
    December 4, 2009

    These comments are starting to smell like hyperbole.

  7. #7 addie
    December 4, 2009

    In addition, new research is tracking related infections on/in the skin of men and women who work in meat-packing plants.

    So, Queef: just keep telling yourself it’s hyperbolic rhetoric while the rest of us figure out how to fix this.

  8. #8 James
    December 4, 2009

    You’re being called hyperbolic because you have not demonstrated what you claim to have demonstrated. I don’t disagree with you that antibiotics have been too freely prescribed in humans and used unwisely in industrial agriculture. Resistance has evolved in both of these regimes.

    What hasn’t been demonstrated (at least by the evidence that you produced) is how much of the resistant bacteria in humans have been caused by industrial agricultural uses of antibiotics.

    The quote you give from Johns Hopkins researchers is “troubling potential source of resistant pathogens: the American farm”. Note “potential”.

  9. #9 addie
    December 4, 2009

    The word “potential” was just used as a sort of grab or catch-all before the article itself commenced. It’s too bad I chose to quote that line because of course “potential” would be seized upon.

    It’s not hyperbole going on here; it’s a real worry, one backed by dozens of sources/do a quick search and very scientific work will emerge for you.

    But I’m used to the accusations, deep sighs, dismissal, threats, ridicule. I just debated the Fac of Agriculture at my U. on intensive agriculture practises –my side clearly won– and a pork producer sent a complaint about me all the way up the ranks to the VP’s. What was the substance of my speech? that ethics involves returning to the systems within which we work in order to keep them open to revision.

    No hyperbole, rhetoric, crazy animal-rights shit there at all.

  10. #10 addie
    December 4, 2009

    From Agribusiness.com (the very people who wouldn’t even want to face this!)

    MRSA is an important cause of hospital-acquired infections and has recently drawn a great deal of attention in both medical journals and the media. The rate of community-acquired MRSA infections has increased in many countries. In the Philippines, there may have been cases of MRSA infections in people but they may not be as popularly published as in other countries. MRSA has been implicated in certain skin and heart infections.

    A series of reports in technical journals have documented a surprisingly high occurrence in pigs and people working with pigs. These reports and findings cause great concerns to swine veterinarians and other people closely exposed to pigs. There is now an unquestionable proof that animals may have an important role in the epidemiology (or the spread) of MRSA infections.

  11. #11 Mike the Mad Biologist
    December 4, 2009

    Addie,

    You’re right that agriculture plays a significant role–type in ‘piggy MRSA’ and search the blog (also try PAMTA). And in Europe (although not the U.S.), vancomycin resistant enterococci stem from the misuse of avopiricin (again, I’ve talked about this too). But MRSA clearly evolved in and spread through the human population–we ‘infected’ the pigs (of course, now the pigs can serve as a reservoir). I would also add that most MRSA in the Netherlands are still human-associated and not agricultural.

    I’ve also talked about NARMS, and how the ag lobby chronically screws it over.

    But the reason I wrote this post is that the economic cost of AR is so devastating, and that’s something policy makers will consider too.

  12. #12 addie
    December 4, 2009

    Thanks Mike.
    It’s just very acronym MSRA sets me off. Sorry for the hijacking :) –but the ag lobby is so strong that sometimes I think meat production & pharmaceuticals = government.

    I like your blog, even though I’m no biologist (English Prof).

    Best, A

  13. #13 sikiş
    December 5, 2009

    Arachnologist and diplopodologist Dr Jason E Bond at East Carolina University in Greenville, NC, is most recently well-known for naming a spider (Myrmekiaphila neilyoungi) after Rock and Roll Hall of Famer, Neil Young. Kristin Day of The Daily Reflector.

  14. #14 TonyP
    December 7, 2009

    Addie and Mike, thanks for the pointers. Addie, I’m sorry that my question infuriated you. I’ve always assumed that the use of antibiotics in farming would result in a rise in antibiotic resistant bacteria, and here seemed to be a good place to ask for evidence supporting that belief. I’m still mystified as to how the “SIGH” got into my comment — when I reread it, it still seems like a straightforward inquiry. Really, I had no agenda, I’m on your side in this, as such things go.

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