STEMMING THE SUPERBUG TIDE Driss Ait Ouakrim OECD Health Division
Prevalence rate (%) AMR Will Keep Increasing If No Effective Actions Are Put in Place Resistance proportions for eight antibiotic-bacterium combinations in the OECD 45 40 35 30 25 20 15 10 5 0 2005 2015 2030
Antimicrobial resistance index [2005 = 100] among selected bug-drug combinations Resistance to 2 nd and 3 rd line Treatments Will Grow the Most 200 OECD countries 200 G20 countries 175 150 2 nd -line 175 150 3 rd -line 2 nd -line 125 100 3 rd -line 125 100 1 st -line 1 st -line 75 2005 2010 2015 2020 2025 2030 75 2005 2010 2015 2020 2025 2030
Average yearly cost of AMR per capita (USD PPP) Health and economic burden of AMR 67 000 deaths per year 3.5B USD PPPs per year 7 6 5 4 3 2 2.14 1 0
Health and economic burden of AMR Deaths per 100 000 people Annual cost per 100 000 people (thousand USD) An average of 94 persons die each year in Slovenia due to infections from eight resistant bacteria. By 2050, an estimated total of 16 000 persons will die due to AMR. Annual cost of AMR: $4.4 million By 2050, health care costs in Slovenia could reach $143 million
Number of countries Only 9 OECD Countries Have Developed and Fund a One-health AMR Action Plan 20 18 16 14 12 10 8 6 4 2 0 No national AMR action plan SVN ROU POL* HUN GRC EST BGR BRA National AMR action plan under development TUR SVK PRT PER MEX MLT ISR CZE CYP COL CHL* CAN National AMR action plan developed CHE ESP ZAF RUS NZL LTU LVA ITA IRL IDN IND DEU FRA FIN DNK BEL AUT AUS ARG National AMR action plan approved by government that reflects Global Action Plan objectives, with an operational plan and monitoring arrangements USA GBR SWE SAU KOR NOR NLD LUX JPN ISL HRV CHN National AMR action plan has funding sources identified, is being implemented, involves relevant sectors and has a defined monitoring and evaluation process
Policy Approaches to Tackle Irrational Use of Antimicrobials Delayed prescriptions Mass media campaigns Stewardship programmes Enhanced environm. hygiene Improved hand hygiene RDTs in GP practices Key aspects Up to 3 days post-dated prescription Education purposes while providing sense of safety Different approaches Messages delivered by major mass media (TV, radio, journals, etc.) Yearly waves cantered on the winter season Educational/ behavioural interventions for physicians; Decision aid tools Implementati on of advanced cleaning techniques (e.g. no touch) Training support Culturechange program on the WHO-5 campaign Cleaning facilities available at the point of care Training for healthcare personnel Early identification of viral/bacter. infections and of AMR Reimburseme nt of test to GP, incentive to use, info for patients Effects in literature 63% filled-in prescriptions 6.5% antibiotic consumption 40% antibiotic prescription 24-68% AMR 26% - 49% hospitalacquired infections 48% hospitalacquired infections 22% antibiotic consumption
Avoided deaths per year Public Health Policies to Tackle AMR Save Lives 0 Improved hand hygiene Stewardship program Enhanced environmental Rapid hygiene diagnostic tests Delayed prescription Mass media campaigns -10,000-20,000-30,000-40,000 EU-28 & EEA US & Canada Australia
Yearly cost per 1,000 persons (USD/PPPs) And Decrease Healthcare Expenditure 450 Decrease in annual hospital costs caused by infections 300 150 0-150 -300-450 Improved hand hygiene Stewardship programmes Implementation cost Enhanced environemental hygiene Rapid diagnostic tests Delayed prescriptions Savings in healthcare expenditure Mass media campaigns Note: columns show the median value across 33 OECD and EU countries; whiskers show min and max values
Average probability across countries Tackling AMR is a Very Good Investment for OECD and EU Countries 100% 80% 60% 40% 20% 0% Improved hand hygiene Delayed prescription Stewardship program Rapid diagnostic tests Enhanced environmental hygiene Mass media campaigns Cost-saving CE ratio>50 000 USD PPP/DALY CE ratio<50 000 USD PPP/DALY Inferior to business as usual
Effects of individual AMR control policies in Slovenia
A 4-Pronged Approach is Needed to Steam the Superbug Tide Stewardship programmes to promote prudent use of antibiotics and end decades of over-prescription Enhanced hygiene in healthcare settings to minimize cross-patient transmission of resistant and susceptible infections mixed-intervention package Mass media campaigns to make people aware of the risks associated with imprudent use of antibiotics Rapid diagnostic tests to detect whether an infection requires antibiotics or not, in primary care settings
A Mixed Intervention Package Would Save up To 47000 Lives per Year in OECD and EU Slovenia: 77
Net savings per capita (USD PPP) A Mixed Intervention Package Would Decrease Healthcare Expenditure by 3 USD/Capita/Year 0-2 -4-2.70-6 -8-10 -12
Key Policy Implications AMR is increasing in the majority of OECD countries and beyond The projected rise in resistance to 2 nd and 3 rd line antibiotics is particularly worrisome Interventions to increase hygiene show the most positive effects but do not address some of the key determinants of AMR Public health interventions to tackle AMR are a costeffective (and very often cost-saving) investment in OECD countries Combining interventions in a comprehensive public health package would provide better results