COST-EFFECTIVENESS OF INTERVENTIONS TO LIMIT THE SPREAD OF AMR A PERSPECTIVE FROM THE OECD Mark Pearson Deputy Director Directorate for Employment, Labour and Social Affairs
Average proportion of infections which are resistant to antimicrobials for 8 bug-drug pairs AMR Will Keep Increasing If No Effective Action is Put in Place 60 55 50 45 40 35 30 25 20 15 10 5 0 2005 2015 2030 Source: OECD analyses based on national data; unpublished data, please do not cite or quote
Antimicrobial resistance index [2005 = 100] among selected bug-drug combinations Resistance to 2 nd - and 3 rd -line Treatments Will Keep Growing OECD countries G20 countries 200 200 175 175 2 nd -line 3 rd -line 150 150 2 nd -line 125 3 rd -line 125 100 100 1 st -line 75 1 st -line 2005 2010 2015 2020 2025 2030 75 2005 2010 2015 2020 2025 2030 Time (years) Time (years) Source: OECD analyses based on national data; unpublished data, please do not cite or quote
Average yearly cost of AMR per capita (USD PPP) AMR Costs 3.5B USD PPPs per Year to the Health Systems of 33 OECD and EU Countries 7 6 5 4 3 2 1 0 Source: OECD analyses based on national data; unpublished data, please do not cite or quote
Policy Approaches to Tackle Irrational Use of Antimicrobials Delayed prescriptions Mass media campaigns Stewardship programmes Enhanced env hygiene Improved hand hygiene RDTs in GP practices Key aspects Up to 3 days post-dated prescription Educative while providing sense of safety Messages delivered by major mass media. Yearly waves around winter Educational/ behavioural interventions for physicians; Decision aid tools Advanced cleaning techniques (e.g. no touch) Training support Culture- change/who- 5 campaign Cleaning facilities at the point of care Training for personnel Early identification of infections and of AMR 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 Source: Cecchini & Lee; OECDPublishing, 2017 - http://dx.doi.org/10.1787/9789264266414-6-en
Avoided deaths per year AMR Prevention Policies Reduce Deaths 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prescription Mass media campaigns -10,000-20,000-30,000-40,000 EU-28 & EEA US & Canada Australia Source: OECD analyses; unpublished data, please do not cite or quote
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 Source: OECD analyses; unpublished data, please do not cite or quote
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 Source: OECD analyses; unpublished data, please do not cite or quote
Health impact (million DALYs) Combining Interventions in a Package Maximizes Impact on Population Health Cumulative impact on health (DALYs) of a hospital-based prevention package in 33 OECD and EU countries 2.5 2.0 1.5 1.0 0.5 0.0 2015 2020 2025 2030 2035 2040 2045 2050 EU-28 & EEA US & Canada Australia Source: OECD analyses; unpublished data, please do not cite or quote
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
OECD Work to Trigger Policy Change Tackling AMR - Economics and Public Health Policy (forthcoming) G20 note on R&D AMR in G7 Countries and Beyond Policy Brief and Policy Insights Promoting rational use of antibiotics background to OECD Health Ministerial Mark.Pearson@oecd.org www.oecd.org/els/health-systems/antimicrobial-resistance