EXECUTIVE SUMMARY

1.Introduction

Antimicrobial resistance (AMR) is one of the biggest challenges to face global public health at the beginning of the third millennium. However, there is little accurate information concerning many aspects of AMR, including, in particular, the cost and/or effectiveness of various strategies which may prevent the emergence of AMR and/or limit the transmission of resistant organisms, or resistance determinants. The Global Forum for Health Research therefore provided funding to:

  1. Review current knowledge concerning the cost and/or effectiveness of (medical) interventions aimed at reducing the emergence and transmission of AMR in humans; and

  2. Explore the feasibility of, and issues involved in, the development of an economic model to assess the cost-effectiveness of interventions to address AMR in humans.

2.Literature review — Methodology

A systematic literature review was undertaken to describe and critically appraise studies reporting on: (i) the costs and/or effectiveness of strategies to prevent, and control the spread of, AMR; and (ii) the cost impact of resistance. Literature was identified through contact with key international figures and institutions in the field of AMR, and through searching major electronic bibliographic databases. Approximately 155 studies were reviewed, following clearly defined inclusion and exclusion, and quality assessment strategies. Meta-analysis was inappropriate, and thus a qualitative overview provided.

3.Literature review — Results

From this review it would appear that most studies:

  1. Are from the developed world (principally the USA);

  2. Are mostly hospital/other institution based, with few community level interventions;

  3. Are concerned with control of transmission as opposed to prevention of emergence;

  4. Cover “micro” interventions, such as hand-washing, and not more “macro” policy interventions, such as legislation, global control of drug availability, tax/subsidy; and



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