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Resistance Elasticity of Antibiotic Demand in Intensive Care

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  • Thomas Heister
  • Christian Hagist
  • Klaus Kaier

Abstract

The emergence and spread of antimicrobial resistance (AMR) is still an unresolved problem worldwide. In intensive care units (ICUs), first‐line antibiotic therapy is highly standardized and widely empiric while treatment failure because of AMR often has severe consequences. Simultaneously, there is a limited number of reserve antibiotics, whose prices and/or side effects are substantially higher than first‐line therapy. This paper explores the implications of resistance‐induced substitution effects in ICUs. The extent of such substitution effects is shown in a dynamic fixed effect regression analysis using a panel of 66 German ICUs with monthly antibiotic use and resistance data between 2001 and 2012. Our findings support the hypothesis that demand for reserve antibiotics substantially increases when resistance towards first‐line agents rises. For some analyses the lagged effect of resistance is also significant, supporting the conjecture that part of the substitution effect is caused by physicians changing antibiotic choices in empiric treatment by adapting their resistance expectation to new information on resistance prevalence. The available information about resistance rates allows physicians to efficiently balance the trade‐off between exacerbating resistance and ensuring treatment success. However, resistance‐induced substitution effects are not free of charge. These effects should be considered an indirect burden of AMR. Copyright © 2016 John Wiley & Sons, Ltd.

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  • Thomas Heister & Christian Hagist & Klaus Kaier, 2017. "Resistance Elasticity of Antibiotic Demand in Intensive Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(7), pages 892-909, July.
    • Handle: RePEc:wly:hlthec:v:26:y:2017:i:7:p:892-909
    DOI: 10.1002/hec.3363
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    Cited by:

    1. Dubois, Pierre & Gökkoca, Gökçe, 2023. "Antibiotic Demand in the Presence of Antimicrobial Resistance," CEPR Discussion Papers 18358, C.E.P.R. Discussion Papers.
    2. Klaus Kaier & Martin Wolkewitz & Philip Hehn & Nico T. Mutters & Thomas Heister, 2020. "The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system," International Journal of Health Economics and Management, Springer, vol. 20(1), pages 1-11, March.

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