IDEAS home Printed from https://ideas.repec.org/a/plo/pgph00/0001589.html
   My bibliography  Save this article

Individual and population level costs and health-related quality of life outcomes of third-generation cephalosporin resistant bloodstream infection in Blantyre, Malawi

Author

Listed:
  • Rebecca Lester
  • James Mango
  • Jane Mallewa
  • Christopher P Jewell
  • David A Lalloo
  • Nicholas A Feasey
  • Hendramoorthy Maheswaran

Abstract

Data which accurately enumerate the economic costs of antimicrobial resistance (AMR) in low- and middle- income countries are essential. This study aimed to quantify the impact of third-generation cephalosporin resistant (3GC-R) bloodstream infection (BSI) on economic and health related quality of life outcomes for adult patients in Blantyre, Malawi. Participants were recruited from a prospective, longitudinal cohort study of hospitalised patients with bloodstream infection caused by Enterobacterales at Queen Elizabeth Central Hospital (QECH). Primary costing studies were used to estimate the direct medical costs associated with the inpatient stay. Recruited participants were asked about direct non-medical and indirect costs associated with their admission and their health-related quality of life was measured using the EuroQol EQ-5D questionnaire. Multiple imputation was undertaken to account for missing data. Costs were adjusted to 2019 US Dollars. Cost and microbiology surveillance data from QECH, Blantyre was used to model the annual cost of, and quality-adjusted life years lost to, 3GC-R and 3GC-Susceptible BSI from 1998 to 2030 in Malawi. The mean health provider cost per participant with 3GC-R BSI was US$110.27 (95%CR; 22.60–197.95), higher than for those with 3GC-S infection. Patients with resistant BSI incurred an additional indirect cost of US$155.48 (95%CR; -67.80, 378.78) and an additional direct non-medical cost of US$20.98 (95%CR; -36.47, 78.42). Health related quality of life outcomes were poor for all participants, but participants with resistant infections had an EQ-5D utility score that was 0.167 (95% CR: -0.035, 0.300) lower than those with sensitive infections. Population level burden estimates suggest that in 2016, 3GC-R accounted for 84% of annual societal costs from admission with bloodstream infection and 82% of QALYs lost. 3GC-R bloodstream infection was associated with higher health provider and patient level costs than 3GC-S infection, as well as poorer HRQoL outcomes. We demonstrate a substantial current and future economic burden to society as a result of 3GC-R E. coli and Klebsiella spp. BSI, data urgently needed by policy makers to provide impetus for implementing strategies to reduce AMR.

Suggested Citation

  • Rebecca Lester & James Mango & Jane Mallewa & Christopher P Jewell & David A Lalloo & Nicholas A Feasey & Hendramoorthy Maheswaran, 2023. "Individual and population level costs and health-related quality of life outcomes of third-generation cephalosporin resistant bloodstream infection in Blantyre, Malawi," PLOS Global Public Health, Public Library of Science, vol. 3(6), pages 1-16, June.
    • Handle: RePEc:plo:pgph00:0001589
    DOI: 10.1371/journal.pgph.0001589
    as

    Download full text from publisher

    File URL: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001589
    Download Restriction: no
    File URL: https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0001589&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pgph.0001589?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884, Decembrie.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Chiranjeev Sanyal & Don Husereau, 2020. "Systematic Review of Economic Evaluations of Services Provided by Community Pharmacists," Applied Health Economics and Health Policy, Springer, vol. 18(3), pages 375-392, June.
    2. Andrew J. Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin & Richard Cookson & Peter Berman, 2020. "Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 4, pages 99-132, World Scientific Publishing Co. Pte. Ltd..
    3. Julie A. Campbell & Glen J. Henson & Valery Fuh Ngwa & Hasnat Ahmad & Bruce V. Taylor & Ingrid Mei & Andrew J. Palmer, 2025. "Estimation of Transition Probabilities from a Large Cohort (> 6000) of Australians Living with Multiple Sclerosis (MS) for Changing Disability Severity Classifications, MS Phenotype, and Disease-Modif," PharmacoEconomics, Springer, vol. 43(2), pages 223-239, February.
    4. Christopher M Doran & Irina Kinchin, 2020. "Economic and epidemiological impact of youth suicide in countries with the highest human development index," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-11, May.
    5. Qi Cao & Erik Buskens & Hans L. Hillege & Tiny Jaarsma & Maarten Postma & Douwe Postmus, 2019. "Stratified treatment recommendation or one-size-fits-all? A health economic insight based on graphical exploration," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 475-482, April.
    6. Dongzhe Hong & Lei Si & Minghuan Jiang & Hui Shao & Wai-kit Ming & Yingnan Zhao & Yan Li & Lizheng Shi, 2019. "Cost Effectiveness of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Dipeptidyl Peptidase-4 (DPP-4) Inhibitors: A Systematic Review," PharmacoEconomics, Springer, vol. 37(6), pages 777-818, June.
    7. Yakubu Adole Agada-Amade & Daniel Chukwuemeka Ogbuabor & Eric Obikeze & Ejemai Eboreime & Obinna Emmanuel Onwujekwe, 2024. "Cost-benefit analysis of haemodialysis in patients with end-stage kidney disease in Abuja, Nigeria," Health Economics Review, Springer, vol. 14(1), pages 1-8, December.
    8. Simon Pol & Paula Rojas Garcia & Fernando Antoñanzas Villar & Maarten J. Postma & Antoinette D. I. Asselt, 2021. "Health-Economic Analyses of Diagnostics: Guidance on Design and Reporting," PharmacoEconomics, Springer, vol. 39(12), pages 1355-1363, December.
    9. Paul Revill & Simon Walker & Valentina Cambiano & Andrew Phillips & Mark J Sculpher, 2018. "Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-13, January.
    10. Omar B. Da'ar & Abdi A. Gele, 2023. "Tuberculosis in a weak health system, conflict and fragile zone: The monetary value of human lives lost associated with deaths of persons older than 14 years in Somalia," International Journal of Health Planning and Management, Wiley Blackwell, vol. 38(1), pages 53-68, January.
    11. Anna Nicolet & Antoinette D I van Asselt & Karin M Vermeulen & Paul F M Krabbe, 2020. "Value judgment of new medical treatments: Societal and patient perspectives to inform priority setting in The Netherlands," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-18, July.
    12. McNamara, Simon & Tsuchiya, Aki & Holmes, John, 2021. "Does the UK-public's aversion to inequalities in health differ by group-labelling and health-gain type? A choice-experiment," Social Science & Medicine, Elsevier, vol. 269(C).
    13. Enxue Chang & Haofei Li & Wanji Zheng & Lan Zhou & Yanni Jia & Wen Gu & Yiyin Cao & Xiaoying Zhu & Juan Xu & Bo Liu & Mao You & Kejun Liu & Mingsi Wang & Weidong Huang, 2024. "Economic Evaluation of COVID-19 Immunization Strategies: A Systematic Review and Narrative Synthesis," Applied Health Economics and Health Policy, Springer, vol. 22(4), pages 457-470, July.
    14. Nikolai Mühlberger & Gaby Sroczynski & Artemisa Gogollari & Beate Jahn & Nora Pashayan & Ewout Steyerberg & Martin Widschwendter & Uwe Siebert, 2021. "Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(8), pages 1311-1344, November.
    15. Zachary Tirrell & Alicia Norman & Martin Hoyle & Sean Lybrand & Bonny Parkinson, 2024. "Bring Out Your Dead: A Review of the Cost Minimisation Approach in Health Technology Assessment Submissions to the Australian Pharmaceutical Benefits Advisory Committee," PharmacoEconomics, Springer, vol. 42(11), pages 1287-1300, November.
    16. Yasuhiro Hagiwara & Takeru Shiroiwa, 2022. "Estimating Value-Based Price and Quantifying Uncertainty around It in Health Technology Assessment: Frequentist and Bayesian Approaches," Medical Decision Making, , vol. 42(5), pages 672-683, July.
    17. Cameron Morgan & Cam Donaldson & Emily Lancsar & Stavros Petrou & Lazaros Andronis, 2024. "Considerations Around the Inclusion of Children and Young People’s Time in Economic Evaluation: Findings from an International Delphi Study," PharmacoEconomics, Springer, vol. 42(11), pages 1267-1277, November.
    18. Dina Jankovic & Pedro Saramago Goncalves & Lina Gega & David Marshall & Kath Wright & Meena Hafidh & Rachel Churchill & Laura Bojke, 2022. "Cost Effectiveness of Digital Interventions for Generalised Anxiety Disorder: A Model-Based Analysis," PharmacoEconomics - Open, Springer, vol. 6(3), pages 377-388, May.
    19. Boshen Jiao & Zafar Zafari & Brian Will & Kai Ruggeri & Shukai Li & Peter Muennig, 2017. "The Cost-Effectiveness of Lowering Permissible Noise Levels Around U.S. Airports," IJERPH, MDPI, vol. 14(12), pages 1-10, December.
    20. Philip J. Cook & Jens Ludwig, 2019. "Understanding Gun Violence: Public Health Vs. Public Policy," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 38(3), pages 788-795, June.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pgph00:0001589. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: globalpubhealth (email available below). General contact details of provider: https://journals.plos.org/globalpublichealth .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.