Exploring the economic impact of inappropriate antibiotic use: the case of upper respiratory tract infections in Ghana

Jip Janssen; Samuel Afari-Asiedu; Annelie Monnier; Martha Ali Abdulai; Theresa Tawiah; Heiman Wertheim; Rob Baltussen; Kwaku Poku Asante

doi:10.1186/s13756-022-01096-w

Exploring the economic impact of inappropriate antibiotic use: the case of upper respiratory tract infections in Ghana

Antimicrob Resist Infect Control. 2022 Apr 1;11(1):53. doi: 10.1186/s13756-022-01096-w.

Authors

Jip Janssen¹, Samuel Afari-Asiedu², Annelie Monnier³, Martha Ali Abdulai², Theresa Tawiah², Heiman Wertheim⁴, Rob Baltussen¹, Kwaku Poku Asante²

Affiliations

¹ Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.
² Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana.
³ Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.
⁴ Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands. heiman.wertheim@radboudumc.nl.

Abstract

Background: Antibiotic consumption is increasing worldwide, particularly in low and middle-income countries (LMICs). Access to lifesaving antibiotics in LMICs is crucial while minimising inappropriate use. Studies assessing the economic impact of inappropriate antibiotic use in LMICs are lacking. We explored the economic impact of inappropriate antibiotic use using the example of upper respiratory tract infections (URIs) in Ghana, as part of the ABACUS (AntiBiotic ACcess and USe) project.

Methods: A top-down, retrospective economic impact analysis of inappropriate antibiotic use for URIs was conducted. Two inappropriate antibiotic use situations were considered: (1) URIs treated with antibiotics, against recommendations from clinical guidelines; and (2) URIs that should have been treated with antibiotics according to clinical guidelines, but were not. The analysis included data collected in Ghana during the ABACUS project (household surveys and exit-interviews among consumers buying antibiotics), scientific literature and stakeholder consultations. Included cost types related to health care seeking behaviour for URIs. Additionally, cost saving projections were computed based on potential effects of future interventions that improve antibiotic use.

Results: Health care costs related to inappropriate antibiotic use for URIs were estimated to be around 20 million (M) USD annually, including 18 M USD for situation 1 and 2 M USD for situation 2. Travel costs and lost income due to travel, together, were estimated to be around 44 M USD for situation 1 and 18 M USD for situation 2. Possible health care cost savings range from 2 to 12 M USD for situation 1 and from 0.2 to 1 M USD for situation 2.

Conclusions: This study indicates that inappropriate antibiotic use leads to substantial economic costs in a LMIC setting that could have been prevented. We recommend investment in novel strategies to counter these unnecessary expenditures. As the projections indicate, this may result in considerable cost reductions. By tackling inappropriate use, progress can be made in combatting antibiotic resistance.

Keywords: Antibiotic resistance; Economic impact analysis; Ghana; Inappropriate antibiotic use; Low and middle-income countries; Upper respiratory tract infection.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents* / therapeutic use
Ghana
Health Care Costs
Humans
Respiratory Tract Infections* / drug therapy
Retrospective Studies

Substances

Anti-Bacterial Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding