Antimicrobial resistance (AMR) remains one of the most pressing global health challenges, threatening to reverse decades of medical progress. AMR occurs when bacteria, viruses, fungi or parasites do not respond to medications designed to treat them, making the infection harder to treat.

Bloodstream infections (BSIs) caused by drug-resistant pathogens pose a particularly significant threat not only to patients’ health but also to their finances.

A recent study conducted in eight tertiary care hospitals in India, including government, private and trust hospitals, highlighted the economic burden of AMR infection. These hospitals, part of the Antimicrobial Resistance Surveillance Network (AMRSN) of the Indian Council of Medical Research (ICMR), followed standardized protocols for blood culture susceptibility testing.

With bed capacity ranging from 560 in private hospitals to over 1,700 in government facilities, the study provides a comprehensive view of the financial implications of AMR.

The research was published in the peer-reviewed British Medical Journal in December and was participated by several institutions such as the National AIDS Research Institute (NARI), Pune; Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry; Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh; Apollo Hospital, Chennai; PD Hinduja Hospital, Mumbai; and Mahatma Gandhi Institute of Medical Sciences, Sevagram.

Financial impact of AMR infection

The study revealed huge differences in treatment costs between resistant and non-resistant infections.

The average total cost for the management of antimicrobial-resistant infections was approximately $199 (Rs 14,712.07 as of 2021-2022 exchange rates), compared with $109 (Rs 8,058) for infections caused by susceptible strains.

The average cost per day for resistant infections was $65 (Rs 4,805.45), almost double the $35 (Rs 2,587.55) for non-resistant infections.

Pharmaceutical expenditure emerged as the largest contributor to these costs, accounting for 61.5% of incremental costs (IC) in government hospitals and 27.1% in private hospitals.

In addition, indirect costs, including loss of income and additional caregiving expenses, placed a significant financial strain on families. What is worrying is that about 46.5% of the patients resorted to borrowing money to cover their hospitalization expenses.

Why are the costs high for AMR infection?

The presence of critical or high-priority pathogens, as identified by the World Health Organization (WHO), significantly increases medical costs, both direct and indirect.

Pathogens such as Enterobacteriaceae, Acinetobacter and Staphylococcus aureus contribute significantly to prolonged hospital stays and increased medication costs.

Comorbidities, length of hospital stay, and final diagnosis also play an important role in determining the overall cost of care. For example, patients infected with resistant strains often require longer hospitalizations and specialized medications, increasing costs.

Globally, AMR infections are responsible for more than 250,000 deaths annually, with an estimated 10 million deaths per year by 2050 if immediate action is not taken.

In India alone, newborn deaths caused by drug-resistant bacteria reached more than 58,000 in 2013. These staggering figures underline the urgency to tackle AMR both medically and economically.

AMR crisis

Study researchers highlight the urgency of implementing the strategies outlined in the National Action Plan for AMR. These include enhancing infection prevention, optimizing antibiotic use, and prioritizing research on pathogen-specific interventions.

From an economic perspective, understanding the incremental costs associated with resistant infections is essential for better resource allocation and policy-making.

By addressing these financial burdens, health care systems can not only save lives, but also prevent families from falling into financial distress due to preventable infections.

More about antimicrobial resistance

Antimicrobial resistance is not only a medical challenge but also a socio-economic challenge. The findings of this study highlight the urgent need for continued investment in AMR surveillance, affordable treatment options, and public health interventions.

Without prompt and coordinated action, the financial and human costs of AMR will continue to increase, disproportionately affecting vulnerable populations in low- and middle-income countries like India.