7 Costs and benefits of strategies to mitigate AMR

To better understand how cost-effectiveness is applied to efforts to mitigate AMR, you are now going to look at a published cost-effectiveness analysis. There are three analyses to choose from, which you can access using the links below. Each considers a different type of intervention relevant to AMR:

You do not need to read all these case studies; you should select the one that interests you most to complete Activity 9. You can answer the first questions by reading only the abstracts; if you want to spend more time on this activity, you can answer additional questions by reading the sections in the articles on methods, discussions and conclusions.

Activity 9: Evaluating costs and benefits of strategies to mitigate AMR in case studies

Timing: Allow about 20 minutes

Once you’ve chosen the article that interests you most, answer the following questions in the space below:

  1. Which strategies or interventions were compared in the analysis?
  2. Did the analysis quantify health outcomes in terms of QALYs or DALYs? If not, what type of health outcome was used instead?
  3. Did the authors conclude whether the interventions were cost-effective?

You may also want to consider the following optional further questions:

  1. What kind of costs were included in the analysis? Do you think any were not recognised?
  2. Did the researchers use a cost-effectiveness threshold? If so, what was it?
  3. What type of data for the effectiveness of interventions were used, and do you think this was appropriate?
  4. What were the key strengths and limitations of the research?
  5. What was the conclusion of the paper? Do you think the conclusions were justified and generalisable to other contexts (such as your own country)?
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Discussion

If you focused on the article about the hand hygiene programme in Mexico (Salinas-Escudero et al., 2023), you may have the following answers:

  1. The analysis compared the implementation of an automated hand-hygiene monitoring system versus non-implementation.
  2. It did not use DALYs or QALYs; health outcomes were quantified in terms of the number of infections.
  3. The automated hand-hygiene monitoring system was estimated to be cost-saving and more effective (with reduced infections), and therefore ‘dominant’.

If you focused on the article about using whole genome sequencing in Australia (Elliott et al. 2021), you may have the following answers:

  1. The analysis compared three scenarios: use of whole genome sequencing and metagenomics; use of just whole genome sequencing; and no whole genome sequencing or metagenomics.
  2. It used QALYs to quantify health outcomes.
  3. It estimated that both intervention scenarios were likely to be cost-effective, with whole genome sequencing and metagenomics estimated to be the most cost-effective strategy.

If you focused on the article about the antimicrobial stewardship programme in Ethiopia (Gebretekle et al., 2021), you may have the following answers:

  1. The analysis compared pharmacist-led antimicrobial stewardship (with concurrent strengthening of laboratory capacity) with usual care.
  2. It used QALYs and expected life years to quantify health outcomes.
  3. The antimicrobial stewardship programme was estimated to be cost-saving and more effective (yielding more QALYs), and therefore cost-effective and dominant.

6.4 Using economic evidence to prioritise interventions

8 Communicating the health and economic burden of AMR in your work