before one is successful in eradicating the infection. The end result is longer and more expensive hospital stays. For the United States as a whole, the American Society for Microbiology estimated in 1995 that health care costs associated with treatment of resistant infections amounted to more than $4 billion annually. And this figure significantly underestimates the actual cost of resistance, since it includes only direct health care costs and excludes an array of other costs, such as lost lives and lost workdays. Moreover, these costs are expected to increase considerably given increasing rates of antimicrobial resistance.

In addition, economics can be used predictively to identify how changes in the health care system might affect the use of antimicrobial agents—and hence the emergence and spread of antimicrobial resistance. These analyses make use of descriptive data, together with conceptual models, to guide choices that are yet to be made.

Economics also can prove vital in developing specific strategies and policies to contain antimicrobial resistance. Key among current available strategies are regulation; charges (taxes) on the use of antimicrobials; and rights to trade (permits, licenses, or marketable property rights), which often are used in an attempt to combine the ease of regulation with the flexibility and efficiency of charges. To fill this role, however, the single biggest problem is lack of a comprehensive economic model for fully assessing the impact of antimicrobial resistance, as well as the cost and effectiveness of interventions to reduce the emergence and transmission of such resistance. Efforts are now under way to develop such a model. And while scientific and epidemiological development is vital, additional support also is required to advance understanding of the economics of resistance.


Richard D. Smith, M.Sc.

School of Medicine, Health Policy & Practice University of East Anglia, Norwich, United Kingdom

“We may look back at the antibiotic era as just a passing phase in the history of medicine, an era when a great natural resource was squandered, and the bugs proved smarter than the scientists” (Cannon, 1995).

We begin the 21st century in a position of retreat against infectious disease, with the latter half of the 20th century in danger of being consigned to the history books as the time when a valuable new resource in this battle was both discovered and squandered.

“Superbugs,” micro-organisms that have become resistant to the major

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