The economic evaluation of antibacterial drugs and externalities from antibacterial drug uses: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

SONG Yihang ¹ , DING Ningxin ² ,  ZHOU Huixuan ³ , DAI Xiaotong ³ ,  ZHANG Wei ⁴

1. Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450007, P.R.China;
2. School of Government, Victoria University of Wellington, Wellington 6012, New Zealand;
3. School of Sport Science, Beijing Sport University, Beijing 100084, P.R.China;
4. China National Institutes for Food and Drug Control, Beijing 102629, P.R.China;

Corresponding?author：

ZHOU Huixuan, Email: chouhuixuan@live.cn; ZHANG Wei, Email: maximer325@163.com

Keywords：

Antibiotics; Antibiotic resistance; Externality; Economic evaluation

DOI：

10.7507/1672-2531.202012158

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Objective To systematically review the health economic evaluation studies in which externalities of antibacterial drug uses were identified.Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect health economic evaluation studies in which externalities of antibacterial drug uses were identified from inception to December 31^st, 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Descriptive analysis was then performed.Results A total of 14 studies were included. Negative externalities and their impacts on costs and/or effectiveness were examined in 13 literature, and positive externalities in terms of an improvement in disease control were included in only one study. No study was found in which both negative and positive externalities were included. The methods used to quantify negative externalities included: only costs associated with drug resistance per prescription or per unit were calculated; both costs and health impacts associated with the second/third line treatments followed a treatment failure (due to drug resistance) were calculated using a decision tree. In one study in which positive externalities were measured, both health gain and cost reduction from an improvement in disease control (as a benefit of antibacterial drug uses) were calculated by constructing a dynamic model at the population level.Conclusions We propose that both the positive and negative externalities should be included in health economic evaluation. This can be achieved by measuring the relevant costs and health impacts in a broader perspective, using a disease-transmission dynamic model. In addition, to achieve an improved health utility measurement, disability-adjusted-life years rather than quality-adjusted-life years should be encouraged for use. Finally, both costs and effectiveness should be discounted.

Citation： SONG Yihang, DING Ningxin, ZHOU Huixuan, DAI Xiaotong, ZHANG Wei. The economic evaluation of antibacterial drugs and externalities from antibacterial drug uses: a systematic review. Chinese Journal of Evidence-Based Medicine, 2021, 21(6): 669-675. doi: 10.7507/1672-2531.202012158 Copy

1.	Kaier K. Economic implications of the dynamic relationship between antibiotic use and hospital-acquired infections. Value Health, 2012, 15(1): 87-93.
2.	O'Neill J. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Review on Antimicrobial Resistance, 2016: 1-16.
3.	劉越男, 張艷晶, 呼明明, 等. 淺談國外抗生素管理策略. 中國新藥雜志, 2014, 23(15): 1836-1842.
4.	Coast J, Smith RD, Millar MR. Superbugs: should antimicrobial resistance be included as a cost in economic evaluation? Health Econ, 1996, 5(3): 217-226.
5.	Coast J, Smith R, Karcher AM, et al. Superbugs II: how should economic evaluation be conducted for interventions which aim to contain antimicrobial resistance? Health Econ, 2002, 11(7): 637-647.
6.	Smith RD, Yago M, Millar M, et al. A macroeconomic approach to evaluating policies to contain antimicrobial resistance: a case study of methicillin-resistant Staphylococcus aureus (MRSA). Appl Health Econ Health Policy, 2006, 5(1): 55-65.
7.	Morton A, Colson A, Leporowski A, et al. How should the value attributes of novel antibiotics be considered in reimbursement decision making? MDM Policy Pract, 2019, 4(2): 2381468319892237.
8.	Evers S, Goossens M, de Vet H, et al. Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria. Int J Technol Assess Health Care, Spring 2005, 21(2): 240-245.
9.	王莉, 胡善聯, 孫鑫, 等. 衛生經濟學分析的系統評價方法與挑戰. 中國循證醫學雜志, 2008, 8(11): 1007-1011.
10.	Goh KL, Cutler A, Chua AB, et al. Optimal treatment for duodenal ulcer disease: a cost-decision analysis in Malaysian patients. J Gastroenterol Hepatol, 1999, 14(1): 32-38.
11.	Jansen JP, Kumar R, Carmeli Y. Cost-effectiveness evaluation of ertapenem versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections accounting for antibiotic resistance. Value Health, 2009, 12(2): 234-244.
12.	Jansen JP, Kumar R, Carmeli Y. Accounting for the development of antibacterial resistance in the cost effectiveness of ertapenem versus piperacillin/tazobactam in the treatment of diabetic foot infections in the UK. Pharmacoeconomics, 2009, 27(12): 1045-1056.
13.	Kongnakorn T, Eckmann C, Bassetti M, et al. Cost-effectiveness analysis comparing ceftazidime/avibactam (CAZ-AVI) as empirical treatment comparing to ceftolozane/tazobactam and to meropenem for complicated intra-abdominal infection (cIAI). Antimicrob Resist Infect Control, 2019, 8: 204.
14.	Kongnakorn T, Wagenlehner F, Falcone M, et al. Cost-effectiveness analysis of ceftazidime/avibactam compared to imipenem as empirical treatment for complicated urinary tract infections. Int J Antimicrob Agents, 2019, 54(5): 633-641.
15.	Lee K, Drekonja DM, Enns EA. Cost-effectiveness of antibiotic prophylaxis strategies for transrectal prostate biopsy in an era of increasing antimicrobial resistance. Value Health, 2018, 21(3): 310-317.
16.	Lin YJ, Lin HC, Yang YF, et al. Shorter antibiotic regimens impact the control efforts in high tuberculosis burden regions of Taiwan. Int J Infect Dis, 2020, 97: 135-142.
17.	Martin M, Quilici S, File T, et al. Cost-effectiveness of empirical prescribing of antimicrobials in community-acquired pneumonia in three countries in the presence of resistance. J Antimicrob Chemother, 2007, 59(5): 977-989.
18.	O'Neill C, Gibson PG, Heaney LG, et al. The cost-effectiveness of azithromycin in reducing exacerbations in uncontrolled asthma. Eur Respir J, 2021, 57(2): 2002436.
19.	Oppong R, Smith RD, Little P, et al. Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance. Br J Gen Pract, 2016, 66(650): e633-639.
20.	Sabes-Figuera R, Segú JL, Puig-Junoy J, et al. Influence of bacterial resistances on the efficiency of antibiotic treatments for community-acquired pneumonia. Eur J Health Econ, 2008, 9(1): 23-32.
21.	Sadler S, Holmes M, Ren S, et al. Cost-effectiveness of antibiotic treatment of uncomplicated urinary tract infection in women: a comparison of four antibiotics. BJGP Open, 2017, 1(3): bjgpopen17X101097.
22.	Wang R, Hacker MR, Lefevre R. Cost-effectiveness of prophylactic antibiotic use to prevent catheter-associated urinary tract infections. Int Urogynecol J, 2020, 31(2): 285-289.
23.	張璐瑩. 厄他培南對比哌拉西林/他唑巴坦治療復雜性腹腔感染的成本效果-分析. 中國藥物評價, 2017, 34(5): 386-389.
24.	Sharma A. Antimicrobial resistance: no action today, no cure tomorrow. Indian J Med Microbiol, 2011, 29(2): 91-92.
25.	Hicks LA, Taylor TH, Hunkler RJ. U.S. outpatient antibiotic prescribing, 2010. N Engl J Med, 2013, 368(15): 1461-1462.
26.	European Centre for Disease Prevention and Control EMA. The bacterial challenge: time to react. Joint technical report. Stockholm: ECDPC, 2009.
27.	European Centre for Disease Prevention and Control. Summary of the latest data on antibiotic consumption in the European Union. Stockholm: ECDPC, 2014.
28.	Van Boeckel TP, Gandra S, Ashok A, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis, 2014, 14(8): 742-750.
29.	Shrestha P, Cooper BS, Coast J, et al. Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use. Antimicrob Resist Infect Control, 2018, 7: 98.
30.	MacAdam H, Zaoutis TE, Gasink LB, et al. Investigating the association between antibiotic use and antibiotic resistance: impact of different methods of categorising prior antibiotic use. Int J Antimicrob Agents, 2006, 28(4): 325-332.
31.	Tacconelli E. Antimicrobial use: risk driver of multidrug resistant microorganisms in healthcare settings. Curr Opin Infect Dis, 2009, 22(4): 352-358.
32.	Holmes EAF, Hughes DA. Challenges for economic evaluation of health care strategies to contain antimicrobial resistance. Antibiotics (Basel), 2019, 8(4): 166.
33.	Franklin M, Thorn J. Self-reported and routinely collected electronic healthcare resource-use data for trial-based economic evaluations: the current state of play in England and considerations for the future. BMC Med Res Methodol, 2019, 19(1): 8.
34.	Wisl?ff T, Hagen G, Hamidi V, et al. Estimating QALY gains in applied studies: a review of cost-utility analyses published in 2010. Pharmacoeconomics, 2014, 32(4): 367-375.
35.	Cassini A, H?gberg LD, Plachouras D, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis, 2019, 19(1): 56-66.

1. Kaier K. Economic implications of the dynamic relationship between antibiotic use and hospital-acquired infections. Value Health, 2012, 15(1): 87-93.
2. O'Neill J. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Review on Antimicrobial Resistance, 2016: 1-16.
3. 劉越男, 張艷晶, 呼明明, 等. 淺談國外抗生素管理策略. 中國新藥雜志, 2014, 23(15): 1836-1842.
4. Coast J, Smith RD, Millar MR. Superbugs: should antimicrobial resistance be included as a cost in economic evaluation? Health Econ, 1996, 5(3): 217-226.
5. Coast J, Smith R, Karcher AM, et al. Superbugs II: how should economic evaluation be conducted for interventions which aim to contain antimicrobial resistance? Health Econ, 2002, 11(7): 637-647.
6. Smith RD, Yago M, Millar M, et al. A macroeconomic approach to evaluating policies to contain antimicrobial resistance: a case study of methicillin-resistant Staphylococcus aureus (MRSA). Appl Health Econ Health Policy, 2006, 5(1): 55-65.
7. Morton A, Colson A, Leporowski A, et al. How should the value attributes of novel antibiotics be considered in reimbursement decision making? MDM Policy Pract, 2019, 4(2): 2381468319892237.
8. Evers S, Goossens M, de Vet H, et al. Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria. Int J Technol Assess Health Care, Spring 2005, 21(2): 240-245.
9. 王莉, 胡善聯, 孫鑫, 等. 衛生經濟學分析的系統評價方法與挑戰. 中國循證醫學雜志, 2008, 8(11): 1007-1011.
10. Goh KL, Cutler A, Chua AB, et al. Optimal treatment for duodenal ulcer disease: a cost-decision analysis in Malaysian patients. J Gastroenterol Hepatol, 1999, 14(1): 32-38.
11. Jansen JP, Kumar R, Carmeli Y. Cost-effectiveness evaluation of ertapenem versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections accounting for antibiotic resistance. Value Health, 2009, 12(2): 234-244.
12. Jansen JP, Kumar R, Carmeli Y. Accounting for the development of antibacterial resistance in the cost effectiveness of ertapenem versus piperacillin/tazobactam in the treatment of diabetic foot infections in the UK. Pharmacoeconomics, 2009, 27(12): 1045-1056.
13. Kongnakorn T, Eckmann C, Bassetti M, et al. Cost-effectiveness analysis comparing ceftazidime/avibactam (CAZ-AVI) as empirical treatment comparing to ceftolozane/tazobactam and to meropenem for complicated intra-abdominal infection (cIAI). Antimicrob Resist Infect Control, 2019, 8: 204.
14. Kongnakorn T, Wagenlehner F, Falcone M, et al. Cost-effectiveness analysis of ceftazidime/avibactam compared to imipenem as empirical treatment for complicated urinary tract infections. Int J Antimicrob Agents, 2019, 54(5): 633-641.
15. Lee K, Drekonja DM, Enns EA. Cost-effectiveness of antibiotic prophylaxis strategies for transrectal prostate biopsy in an era of increasing antimicrobial resistance. Value Health, 2018, 21(3): 310-317.
16. Lin YJ, Lin HC, Yang YF, et al. Shorter antibiotic regimens impact the control efforts in high tuberculosis burden regions of Taiwan. Int J Infect Dis, 2020, 97: 135-142.
17. Martin M, Quilici S, File T, et al. Cost-effectiveness of empirical prescribing of antimicrobials in community-acquired pneumonia in three countries in the presence of resistance. J Antimicrob Chemother, 2007, 59(5): 977-989.
18. O'Neill C, Gibson PG, Heaney LG, et al. The cost-effectiveness of azithromycin in reducing exacerbations in uncontrolled asthma. Eur Respir J, 2021, 57(2): 2002436.
19. Oppong R, Smith RD, Little P, et al. Cost effectiveness of amoxicillin for lower respiratory tract infections in primary care: an economic evaluation accounting for the cost of antimicrobial resistance. Br J Gen Pract, 2016, 66(650): e633-639.
20. Sabes-Figuera R, Segú JL, Puig-Junoy J, et al. Influence of bacterial resistances on the efficiency of antibiotic treatments for community-acquired pneumonia. Eur J Health Econ, 2008, 9(1): 23-32.
21. Sadler S, Holmes M, Ren S, et al. Cost-effectiveness of antibiotic treatment of uncomplicated urinary tract infection in women: a comparison of four antibiotics. BJGP Open, 2017, 1(3): bjgpopen17X101097.
22. Wang R, Hacker MR, Lefevre R. Cost-effectiveness of prophylactic antibiotic use to prevent catheter-associated urinary tract infections. Int Urogynecol J, 2020, 31(2): 285-289.
23. 張璐瑩. 厄他培南對比哌拉西林/他唑巴坦治療復雜性腹腔感染的成本效果-分析. 中國藥物評價, 2017, 34(5): 386-389.
24. Sharma A. Antimicrobial resistance: no action today, no cure tomorrow. Indian J Med Microbiol, 2011, 29(2): 91-92.
25. Hicks LA, Taylor TH, Hunkler RJ. U.S. outpatient antibiotic prescribing, 2010. N Engl J Med, 2013, 368(15): 1461-1462.
26. European Centre for Disease Prevention and Control EMA. The bacterial challenge: time to react. Joint technical report. Stockholm: ECDPC, 2009.
27. European Centre for Disease Prevention and Control. Summary of the latest data on antibiotic consumption in the European Union. Stockholm: ECDPC, 2014.
28. Van Boeckel TP, Gandra S, Ashok A, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis, 2014, 14(8): 742-750.
29. Shrestha P, Cooper BS, Coast J, et al. Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use. Antimicrob Resist Infect Control, 2018, 7: 98.
30. MacAdam H, Zaoutis TE, Gasink LB, et al. Investigating the association between antibiotic use and antibiotic resistance: impact of different methods of categorising prior antibiotic use. Int J Antimicrob Agents, 2006, 28(4): 325-332.
31. Tacconelli E. Antimicrobial use: risk driver of multidrug resistant microorganisms in healthcare settings. Curr Opin Infect Dis, 2009, 22(4): 352-358.
32. Holmes EAF, Hughes DA. Challenges for economic evaluation of health care strategies to contain antimicrobial resistance. Antibiotics (Basel), 2019, 8(4): 166.
33. Franklin M, Thorn J. Self-reported and routinely collected electronic healthcare resource-use data for trial-based economic evaluations: the current state of play in England and considerations for the future. BMC Med Res Methodol, 2019, 19(1): 8.
34. Wisl?ff T, Hagen G, Hamidi V, et al. Estimating QALY gains in applied studies: a review of cost-utility analyses published in 2010. Pharmacoeconomics, 2014, 32(4): 367-375.
35. Cassini A, H?gberg LD, Plachouras D, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis, 2019, 19(1): 56-66.

Chinese Journal of Evidence-Based Medicine

The economic evaluation of antibacterial drugs and externalities from antibacterial drug uses: a systematic review

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