The Cost of Resistance

Antibiotic resistance has devastating economic and social costs. In 2009, the Alliance for the Prudent Use of Antibiotics (APUA), in conjunction with a Chicago teaching hospital, conducted a study of the medical and societal costs attributable to antimicrobial-resistant infections (ARI) and the implications of antibiotic stewardship. In its Clinical Infectious Diseases report by Roberts et al. the medical costs for ARI treatment, including those associated with duration of hospital stay, comorbidities, ICU, surgery, and mortality ranged from $18,588 to $29,069 per patient. The team extrapolated that $10.7 to $15.0 million in societal costs can be attributed to antibiotic resistance. In a press release from October 19, 2009 Dr. Roberts is quoted: “Assuming 900,000 ARI cases in the year 2000, based on the conservative selection criteria used in our study, the total societal costs of ARIs to U.S. households in the year 2000 was approximately $35 billion. This includes lost wages from extended hospital stays and from premature deaths.”  Regarding the report, President and co-founder of APUA, and Tufts University professor Dr. Stuart Levy said, “The results offer some good insight regarding just how much ARIs are costing the nation: not just in terms of dollars, but human life and suffering. As the enormous costs identified here are viewed on a national scale, it is clear that effectively addressing the issue of antimicrobial-resistant infection is an essential element for stemming the rising tide of healthcare costs in the United States."

As of September 2013, the CDC has continued to cite APUA’s assessment, stating that “antibiotic resistance adds $20 billion in excess direct health care costs, with additional costs to society for lost productivity as high as $35 billion per year.” In its original 2013 Report, the CDC states the following about estimating total costs:
“This report does not provide a specific estimate for the financial cost of antibiotic-resistant infections. Although a variety of studies have attempted to estimate costs in limited settings, such as a single hospital or group of hospitals, the methods used are quite variable. Similarly, careful work has been done to estimate costs for specific pathogens, such as Streptococcus pneumoniae and MRSA.  However, no consensus methodology currently exists for making such monetary estimates for many of the other pathogens listed in this report.  For this reason, this report references non-CDC estimates in the introduction, but does not attempt to estimate the overall financial burden of antibiotic resistance to the United States."

Additional studies and examples examining the economic and societal costs of antibiotic resistance include:
  • Betsey McCaughy, health policy expert and chairman of Reduce Infection Deaths (RID), estimates $30.5 billion for total hospital-acquired infection costs (2014).
  • Lloyd-Smith et al. analyze the costs of vancomycin-resistant enterococci in Canadian hospitals and estimates $17,949 Canadian dollars per ARI-patient (2013).
  • Dr. Richard Shannon, University of Pennsylvania School of Medicine, estimates $5 billion of additional health care costs can be avoided by eliminating hospital-acquired infections (2011). His presentation can be found here.
  • Dr. J.A. O’Brien et al. summarize the costs of Clostridium difficile (C. diff) infections in Massachusetts hospitals to be $3.2 billion per year (2007).
  • Dr. S. Cosgrove et al. state that patients with ARI cost $6,000-$30,000 more than patients with infections due to antimicrobial-susceptible organisms (2006).



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