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Review
. 2025 Jun 5;15(1):47.
doi: 10.1186/s13561-025-00644-5.

Economic costing methodologies for drug-resistant bacterial infections in humans in low-and middle-income countries: a systematic review

Edward Masoambeta  1 , Charity Mkwanda  2 , Edna Ibrahim  2 , Kenneth Chizani  2   3 , Chikondi Chapuma  3 , Priscilla Dzanja  3 , Edson Mwinjiwa  2   3 , Raphael Chanda  4 , Mirfin Mpundu  5 , Luigia Scudeller  6 , Tomislav Kostyanev  7 , Finola Leonard  8 , Surbhi Malhotra-Kumar  9 , Fiammetta Bozzani  10 , Eric Umar  2 , Rajab Mkakosya  2 , Chantal Morel  11 , Chisomo Msefula  2 , Jobiba Chinkhumba  2
Affiliations
Review

Economic costing methodologies for drug-resistant bacterial infections in humans in low-and middle-income countries: a systematic review

Edward Masoambeta et al. Health Econ Rev. .

Abstract

Background: This review examined methodologies used to cost the impact of antimicrobial resistance (AMR) infections in humans from household and health system perspectives. Although extensive research has been conducted on the clinical AMR burden in low- and middle-income countries (LMICs) in terms of prevalence and other drivers of antimicrobial resistance, there is increased misuse and overuse of antibiotics which increases the risk of AMR infections compared to high-income countries. Lack of comprehensive estimates on economic costs of AMR in LMICs due to lack of standard methodologies that incorporate time biases and inference for instance, may negatively affect accuracy and robustness of results needed for reliable and actionable policies.

Methods: We conducted a systematic review of studies searched in PubMed and other electronic databases. Only studies from LMICs were included. Data were extracted via a modified Covidence template and a Joanna Briggs Institute (JBI) assessment tool for economic evaluations to assess the quality of the papers.

Results: Using PRISMA, 2542 papers were screened at the title and abstract levels, of which 148 were retrieved for full-text review. Of these, 62 articles met the inclusion criteria. The articles had a quality assessment score averaging 85%, ranging from 63 to 100%. Most studies, 13, were from China (21%), followed by 8 from South Africa (13%). Tuberculosis (TB), general bacterial, and nosocomial infection costs are the most studied, accounting for 40%, 39%, and 6%, respectively with TB common in South Africa than the rest of the countries. The majority of the papers used a microcosting approach (71%), followed by gross costing (27%), while the remainder used both. Most studies analyzed costs descriptively (61%), followed by studies using regression-based techniques (17%) and propensity score matching (5%), among others.

Conclusion: Overall, the use of descriptive statistics without justification, limited consideration for potential data challenges, including confounders, and short-term horizons suggest that the full AMR cost burden in humans in LMICs has not been well accounted for. Given the limited data available for these studies, the use of a combination of methodologies may help triangulate more accurate and policy-relevant estimates. While the resources to conduct such cost studies are limited, the use of modeling costs via regression techniques while adjusting for cofounding could help maximize robustness and better estimate the vast and varied burden derived directly and indirectly from AMR.

Keywords: Antimicrobial resistance; Costing methodologies; Economic costs.

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Conflict of interest statement

Declarations. Systematic review protocol registration: This review was registered with the International Platform of Registered Systematic Reviews and Meta-Analysis Protocols (INPLASY) on 2nd July, 2024. The registration number is INPLASY202470004, and the DOI number is https://doi.org/10.37766/inplasy2024.7.0004 . Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart showing the identification, screening and inclusion of studies for a systematic review of economic costing methodologies for treating antibiotic-resistant infections in LMICs
Fig. 2
Fig. 2
Study designs
Fig. 3
Fig. 3
Map showing countries and infection type
Fig. 4
Fig. 4
Distribution of papers by country and infection type
See this image and copyright information in PMC

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