Skip to main content

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

From: The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis

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