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Economic Effects of Environmental Exposure to AMR Ramanan Laxminarayan Twitter @CDDEP

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Page 1: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Economic Effects of Environmental Exposure to AMR

Ramanan LaxminarayanTwitter @CDDEP

Page 2: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

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2030 2030 2050 2050

Low-AMR High-AMR Low-AMR High-AMR

Simulation scenario and year

• Low-income countries

• Rest of the world (all other countries)

Additional people falling into extreme poverty:

nearly 8 million by 2030 in the low-AMR case;

more then 28 million by 2050 in the high-AMR case

Source: Simulation results and author's calculations.

Page 3: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

,(1) - ......... Souroes of antibiot ics and 1resi:stant bacteria

The roles of the environment in antibiot ic iresist ance development .. ,,,... ............................................. __ >:: • • • • • ~- ~ .....it ...... • • • • • • • • -<-- ...... • • • ·•

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,( 3) • • _ ......._ IExpos ure 1routes to .,,..- h umans

,(4) •• • •••• • Poss,ib le interventio'n barll'liers

Page 4: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Pathways of impact

• Via human health• Drug resistant infections• Long term effects of antibiotic exposure

• Via animal health

Page 5: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Benefit-cost of interventions – open questions• Should we focus on measures primarily protecting the environment

from exposure to selective agents, resistant bacteria and genes, ormeasures that protect humans from resistant bacteria and resistancedeterminants of environmental origin?

• Does it make economic sense to focus at the regional or national levelor focus on certain regions of the world, even if distant?

• Should we prioritize investments in waste management in certainsectors, such as clinical or pharmaceutical facilities over others?

• How do investments in behavior change compare against investmentsin technological interventions?

Page 6: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Anthropological and socioeconomic factors contributing to

global antimicrobial resistance: a univariate and

multivariable analysis

+~® CrossMark

Peter Collignon, John) Beggs, Timothy RWalsh, Sumanth Gandra, Ramanan Laxminarayan m Summary Background Understanding of the factors driving global antimicrobial resistance is limited. We analysed antimicrobial resistance and antibiotic consumption worldwide versus many potential contributing factors .

LancetPlanetHealth2018;

2:e39S-4o5

Page 7: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

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Figure 2'; Esd1,erichia coli resista11c1e fevelis. for filu o ri0quinol!o 11e-s and t h i rd~ge:nrerati o 11 cephallos-por1i ms. comp a r,ed with a rnt ilbi otic consumpt ion

Page 8: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Usage (standard· sed)

Governance i nd@x

Health expenditure i r1dex

G [)p per c · pita 1(stand · rdis@d~

Education index

Inf rastrudbu re i r1dex

Climate ir1dex

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GDP= gross domestic product. R2 =coeffide nt of determi r1at i'on.

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Table 1; tfe iof cha es in i rndi e r s sta e of Esdl,eric:hia ooJJ to tl ·. -g e me rat ion c phal,ospo ri ns fl oroqu o ornes

Page 9: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Wat

er

Patients

Healthcare Workers

Acinetobacter spp.Candida spp.

Citrobacter spp.Coagulase negative staphylococci (CONS)

Enterobacter spp.Escherichia coli

Klebsiella pneumoniaPseudomonas spp.

Stahylococcus aureus

Page 10: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

WASH and maternal/newborn health in low-and middle—income countries• Assess the impact of improvements in water, sanitation, and hygiene

(WASH) on reducing bacterial HAIs in mothers giving birth and in their neonates in low- and middle-income countries (LMICs)

• Develop cost-effectiveness estimates for WASH improvements in LMICs

• Identify gaps where research on WASH interventions can improve health-outcomes for pregnant mothers and neonates in LMICs

Page 11: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Cost effectiveness of interventionsTable 14. I11ere1nental Cost-Effectiveness l.nte1"'\rention Scena1•io

DeatJ1s/ fufections/ DALYs Averted

Inc1•en1e11tal Cost(INR)

lnc1•e1ne11tal Cost($) ICER(INR) ICER($)

Deaths

1 -> baseline 145,369 4.5 32,405 210,680 46,964 5-> 1 319,881 7.0 45,858 46,3,596 66,461 2-> 1 ,377,604 3.2 117,704 547,252 170,.s,86

3 -> 2 l , 88,9, 736 101.0 18,.716 2,,7.38, 74 7 27,124

4-> .2 2 ,.3S3,905 104.3 22,567 3,,411,457 32,705 Infections

1-> baseline 145,,369 14.1 10,,337 210,6.80 14,982

5-> 1 319,881 .21.1 1.5,,142 463,596 .21,945,

2-> 1 ,377,604 11.,3 ' 33 ., 3 9' ·2 - 547,252 4.8,293 3 -> 2 1,889,736 311.6 6,065 2,73.8,747 8 ,790 4-> .2 2,,353,905 322.4 7,301 3,,411,457 10,581

Page 12: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Study Conclusions

1. WASH interventions can be effective but are an expensive way ofaddressing AMR in hospitals

2. Water interventions are necessary because they facilitate IPC3. Without IPC, water-based interventions are not nearly effective

enough alone4. Sanitation improvements only marginally impacted HAIs5. Water-based interventions are more cost-effective than non-water-

based interventions

Page 13: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Disrupted Gut Bacteria Lead to Obesity

LM Cox et al., Cell 158, 705–721, August 14, 2014

Page 14: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Bailey et al, JAMA Pediatrics, 2014

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Page 15: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

69% of children were exposed to antibiotics before end of first yearThis increase was associated with increased risk to obesity, with broad spectrum antibiotics having a more significant role.

Bailey et al, JAMA Pediatrics, 2014

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Page 16: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Costs of childhood obesity in the United States

On in five school age children (about 11 million children in total) is classified as obese according to CDC. If we project a 5% increase in childhood obesity rates attributable environmental exposures, the lifetime cost would be in the order of about $9.2 billion (2011 dollars) in the US alone.

Page 17: Economic Effects of Environmental Exposure to AMRLow-AMR High-AMR Low-AMR High-AMR Simulation scenario and year • Low-income countries • Rest of the world (all other countries)

Thank you