The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
Ambulatory antibiotic prescribing contributes to the development of antibiotic resistance and increases societal costs. Here, we estimate the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States.



In an exploratory analysis, we used published data to develop point and range estimates for the hidden societal cost of antibiotic resistance (SCAR) attributable to each ambulatory antibiotic prescription in the United States. We developed four estimation methods that focused on the antibiotic-resistance attributable costs of hospitalization, second-line inpatient antibiotic use, second-line outpatient antibiotic use, and antibiotic stewardship, then summed the estimates across all methods.



The total SCAR attributable to each ambulatory antibiotic prescription was estimated to be $13 (range: $3-$95). The greatest contributor to the total SCAR was the cost of hospitalization ($9; 69 % of the total SCAR). The costs of second-line inpatient antibiotic use ($1; 8 % of the total SCAR), second-line outpatient antibiotic use ($2; 15 % of the total SCAR) and antibiotic stewardship ($1; 8 %). This apperars to be an error.; of the total SCAR) were modest contributors to the total SCAR. Assuming an average antibiotic cost of $20, the total SCAR attributable to each ambulatory antibiotic prescription would increase antibiotic costs by 65 % (range: 15-475 %) if incorporated into antibiotic costs paid by patients or payers.



Each ambulatory antibiotic prescription is associated with a hidden SCAR that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. cmichaelidis@partners.org.|PGY-3, Internal Medicine, Brigham and Women's Hospital, 75 Frances Street, Boston, MA, 02115, USA. cmichaelidis@partners.org.
Constantinos I
CI
Michaelidis
Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.|Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Michael J
MJ
Fine
Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Chyongchiou Jeng
CJ
Lin
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Jeffrey A
JA
Linder
Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Mary Patricia
MP
Nowalk
Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ryan K
RK
Shields
Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Richard K
RK
Zimmerman
Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Kenneth J
KJ
Smith
D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D004352:Drug Resistance, Microbial / Q000187:drug effects / Q000502:physiology*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D014481:United States
D000900:Anti-Bacterial Agents
Antibiotic resistance; Negative externality; Primary care; Societal costs; Stewardship