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Attributable Patient Cost of Antimicrobial Resistance: A Prospective Parallel Cohort Study in Two Public Teaching Hospitals in Ghana

Author

Listed:
  • Evans Otieku

    (University of Ghana
    Aarhus University)

  • Ama Pokuaa Fenny

    (University of Ghana)

  • Appiah-Korang Labi

    (Korle-Bu Teaching Hospital
    World Health Organization Regional Office for Africa, Ghana, Country Office)

  • Alex Owusu Ofori

    (Komfo Anokye Teaching Hospital
    Kwame Nkrumah University of Science and Technology)

  • Joergen Anders Lindholm Kurtzhals

    (University of Copenhagen
    Copenhagen University Hospital)

  • Ulrika Enemark

    (Aarhus University)

Abstract

Objective The aim of this study was to evaluate the attributable patient cost of antimicrobial resistance (AMR) in Ghana to provide empirical evidence to make a case for improved AMR preventive strategies in hospitals and the general population. Methods A prospective parallel cohort design in which participants were enrolled at the time of hospital admission and remained until 30 days after the diagnosis of bacteraemia or discharge from the hospital/death. Patients were matched on age group (± 5 years the age of AMR patients), treatment ward, sex, and bacteraemia type. The AMR cohort included all inpatients with a positive blood culture of Escherichia coli or Klebsiella spp., resistant to third-generation cephalosporins (3GC), or methicillin-resistant Staphylococcus aureus (MRSA). We matched the AMR cohort (n = 404) with two control arms, i.e., patients with the same bacterial infections susceptible to 3GC or S. aureus that was methicillin-susceptible (susceptible cohort; n = 152), and uninfected patients (uninfected cohort; n = 404). Settings were Korle-Bu and Komfo Anokye Teaching Hospitals, Ghana. The outcome measures were the length of hospital stay (LOS) and the associated patient costs. Outcomes were evaluated from the patient perspective. Results From a total of 5752 blood cultures screened, 1836 participants had growth in blood culture, of which, based on our inclusion criteria, 426 were enrolled into the AMR cohort; however, only 404 completed the follow-up and were matched with participants in the two control cohorts. Patients in the AMR cohort stayed approximately 5 more days (95% confidence interval [CI] 4.0–6.0) and 8 more days (95% CI 7.2–8.6) compared with the susceptible and uninfected cohorts, respectively. The mean extra patient cost due to AMR relative to the susceptible cohort was US$1300 (95% CI 1018–1370), of which about 30% resulted from productivity loss due to presenteeism and absenteeism from work. Overall, the estimated annual patient cost due to AMR translates to about US$1 million and US$1.4 million when compared with the susceptible and uninfected cohorts, respectively. Conclusion We have shown that AMR is associated with a significant excess LOS and patient costs in Ghana using prospective data from two public tertiary hospitals. This calls for infection prevention and control strategies aimed at mitigating the prevalence of AMR.

Suggested Citation

  • Evans Otieku & Ama Pokuaa Fenny & Appiah-Korang Labi & Alex Owusu Ofori & Joergen Anders Lindholm Kurtzhals & Ulrika Enemark, 2023. "Attributable Patient Cost of Antimicrobial Resistance: A Prospective Parallel Cohort Study in Two Public Teaching Hospitals in Ghana," PharmacoEconomics - Open, Springer, vol. 7(2), pages 257-271, March.
    • Handle: RePEc:spr:pharmo:v:7:y:2023:i:2:d:10.1007_s41669-022-00385-9
    DOI: 10.1007/s41669-022-00385-9
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    References listed on IDEAS

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    1. Steven Simoens, 2009. "Health Economic Assessment: A Methodological Primer," IJERPH, MDPI, vol. 6(12), pages 1-17, November.
    2. Antonius M van Rijt & Jan-Willem H Dik & Mariëtte Lokate & Maarten J Postma & Alex W Friedrich, 2018. "Cost analysis of outbreaks with Methicillin-resistant Staphylococcus aureus (MRSA) in Dutch long-term care facilities (LTCF)," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-12, November.
    3. Ama Pokuaa Fenny & Evans Otieku & Kwaku Appiah-Korang Labi & Felix Ankomah Asante & Ulrika Enemark, 2021. "Costs and Extra Length of Stay because of Neonatal Bloodstream Infection at a Teaching Hospital in Ghana," PharmacoEconomics - Open, Springer, vol. 5(1), pages 111-120, March.
    4. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
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