By Elly Nuwamanya (BSc., MSc.), CAMO-Net Health Economist, Infectious Diseases Institute, CAMO-Net Uganda
Antibiotics have long been a pillar of modern medicine, leading to significant breakthroughs in treating many infectious diseases. By averting deaths and boosting productivity, antibiotics have had a considerable positive impact on society. However, as economies continue to grow and advance in technology, there is an increase in misuse, overuse, and inappropriate prescriptions of antibiotics, which has compromised (or may compromise) the significant health benefits of antibiotics. Antibiotic resistance (ABR) is the gradual, natural process in which bacteria refuse to respond to antibiotics. If not managed, it compromises the significant benefits we enjoy from antibiotic use and the advancement in the management of most diseases, such as cancer, Tuberculosis, and Malaria through prolonged hospital stays, heavy patient burden on health systems, and high national economic costs in the form of lost income due to productivity losses.
The rationale for ABR economic burden estimates:
Without evidence, decision-makers cannot implement interventions to curb the misuse and overuse of antibiotics and inappropriate prescriptions. Thus, AMR economic burden estimates provide governments and other policymakers a benchmark for robust interventions to reduce AMR. However, these estimates are scanty and non-existent in low-income countries, yet these countries contribute a big deal to the adverse effects of ABR. Recognizing this, the Infectious Diseases Institute (IDI), through the Centres for Antimicrobial Optimization Network (CAMONET), has taken a proactive role in estimating the economic burden of ABR in Uganda and addressing this evidence gap.
Data collection, cleaning, and analysis on the economic burden of ABR in Uganda:
From March to May 2024, activities included designing and revising the costing standard operating procedure (SOP), training research assistants, collecting data across nine regional referral hospitals, and cleaning data. Two teams, each with a research assistant and a supervisor, were created to complete data collection. Each team sought permission and clearance from the hospital director and administrator, who then assigned one of their staff to help in the data collection exercise. The costing SOP was designed to capture all costs related to inpatient care in the major wards of the hospital—Medical, Maternity, Paediatric, Surgical, and Orthopedic—and other units, such as laboratory, intensive care unit, general theatre, and outpatient. Under the assumption that these costs were potentially related to the treatment of ABR patients, we captured data on the size of each ward and unit, equipment in each ward and unit, number of medical and non-medical staff, laboratory supplies and consumables, sundries and antibiotics, number of training, number of cars, motorbikes, ambulances, and generators (with their associated costs), the amount spent on utilities (electricity, water and other administration costs), and waste management. After data collection, data cleaning and curation were done to ensure that the data entered in the online database matched the research assistant’s records and observations.
The study was conducted from a disaggregated societal perspective, considering both the viewpoint of the patient and the health system. Data on patient-related costs such as transport, accommodation, food, out-of-pocket expenses, informal care, and productivity losses was obtained from the literature. In the final analysis, we aimed to estimate the total annual costs of ABR to patients and the Ministry of Health (health system) and the mean annual cost per resistant and susceptible case of ABR. We believe that the results from this study will show the yearly economic losses related to ABR or the amount of money that would be saved if interventions to curb ABR were implemented. This data will also be processed and stored in an electronic database for future use.
Challenges and Lessons Learnt:
Collecting granular economic data is time-consuming and expensive. Additionally, researchers may be denied access to data or given the wrong data by facility personnel because economic data collection may be perceived as “an audit of financial performance” at health facilities. Through proper engagement and benchmarking existing partnerships with the hospital administration on closing projects on ABR surveillance, such as The Fleming Fund, we managed to collect these data smoothly. In addition, these data were collected with the full support of the study lead and trusted hospital staff – who acted as gatekeepers – and well-trained research assistants.
Partners and Collaborators:
This researcher is affiliated with the Wellcome Trust CAMO-Net programme [grant ref: 226692/Z/22/Z].
What to watch out for:
The final analysis results will be presented to local and international audiences through the CAMONET PI meeting, IDI Research Forum, Ministry of Health Technical Working Groups, AMR-related conferences, and a peer-reviewed journal article.
