Table 1 Parameters used to estimate the hidden societal cost of antibiotic resistance (SCAR) attributable to each ambulatory antibiotic prescription in the U.S. arising from four cost components
Parameters | Base Case | Range | Source |
|---|---|---|---|
SCAR Component #1: Hospitalization Cost | |||
Annual hospitalization costs due to resistant infections (US$, millions) | 41,000 | 6,000–60,000 | 12–14 |
Percentage of annual hospitalization costs due to incremental costs | |||
of antibiotic-resistant versus -susceptible infections (%) | 35 | 25–45 | 15,16 |
SCAR Component #2: Second-Line Inpatient Antibiotic Cost | |||
Annual antibiotic costs for resistant infections (US$, millions) | |||
Linezolid | 743 | 594–892 | 17 |
Daptomycin | 713 | 570–856 | 18 |
Carbapenems | 474 | 379–569 | 19 |
Vancomycin | 292 | 234–350 | 19 |
Tigecycline | 148 | 118–178 | 20 |
Ceftaroline | 88 | 58–118 | 21 |
Annual U.S. antibiotic costs for susceptible infections as | |||
a percentage of costs for resistant infections (%) | 30 | 10–50 | 22 |
SCAR Component #3: Second-Line Outpatient Antibiotic Cost | |||
Antibiotic mix in the resistance scenario (%) | |||
Narrow-spectrum penicillins | 20 | 16–24 | 23,24 |
First-generation cephalosporins | 9 | 7–11 | 23,24 |
Sulfonamides | 8 | 5–11 | 23,24 |
Tetracyclines | 6 | 5–7 | 23,24 |
Macrolides | 20 | 17–23 | 23,24 |
Quinolones | 17 | 15–19 | 23,24 |
Broad-spectrum cephalosporins | 9 | 8–10 | 23,24 |
Broad-spectrum penicillins | 9 | 8–10 | 23,24 |
Lincomycin derivatives | 2 | 1–3 | 23,24 |
Antibiotic mix in the no resistance scenario (%) | |||
Narrow-spectrum penicillins | 32 | 30–34 | 23,24 Estimate |
First-generation cephalosporins | 14 | 12–16 | 23,24 Estimate |
Sulfonamides | 13 | 11–15 | 23,24 Estimate |
Tetracyclines | 9 | 7–11 | 23,24 Estimate |
Macrolides | 32 | 28–36 | 23,24 Estimate |
Average cost per antibiotic class (US$) | |||
Narrow-spectrum penicillins (penicillin) | 10 | 4–40 | 26, Estimate |
First-generation cephalosporins (cephalexin) | 15 | 4–40 | 26, Estimate |
Sulfonamides (trimethoprim-sulfamethoxazole) | 10 | 4–40 | 26, Estimate |
Tetracyclines (doxycycline) | 20 | 5–100 | 26, Estimate |
Macrolides (azithro, clarithro and erythromycin) | 25 | 10–200 | 26, Estimate |
Quinolones (cipro, levo and moxifloxacin) | 25 | 4–200 | 26, Estimate |
Broad-spectrum cephalosporins (cefuroxime, cefdinir) | 50 | 25–200 | 26, Estimate |
Broad-spectrum penicillins (amoxicillin-clavulanate) | 120 | 90–150 | 26, Estimate |
Lincomycin derivatives (clindamycin) | 50 | 20–80 | 26, Estimate |
SCAR Component #4: Antibiotic Stewardship Cost | |||
Acute care hospital beds, U.S. (thousands) | 924 | Not varied | 28 |
Staff full time equivalents, stewardship program per 200 beds | |||
Pharmacist | 1.0 | 0.3–2.0 | 29 |
Physician | 0.25 | 0.0–1.0 | 29 |
Annual salary ($US) | |||
Pharmacist, Infectious Diseases | 120,000 | 100,000–140,000 | 30 |
Physician, Infectious Diseases | 190,000 | 150,000–230,000 | 31 |
Salary multiplier for fringe benefits (%) | 120 | 110–130 | Estimate |
Annual educational costs per 200 beds ($US) | 15,000 | 10,000–20,000 | Estimate |
SCAR Components #1-4 | |||
Antibiotics prescribed to humans, by weight (%) | 20 | 15–25 | 9 |
Relative weighting of human versus animal antibiotic use | 1:1 | 1:1–3:1 | Estimate |
on human antibiotic resistance costs | |||
Antibiotics prescribed in ambulatory setting (%) | 80 | 70–90 | 3 |
Annual ambulatory antibiotic prescriptions (millions) | 263 | 213–313 | 8 |