Intended for healthcare professionals


The true cost of antimicrobial resistance

BMJ 2013; 346 doi: (Published 11 March 2013) Cite this as: BMJ 2013;346:f1493
  1. Richard Smith, professor of health system economics 1,
  2. Joanna Coast, professor of health economics2
  1. 1London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
  2. 2School of Health and Population Sciences, University of Birmingham. Birmingham, UK
  1. Correspondence to: R Smith Richard.Smith{at}

Richard Smith and Joanna Coast argue that current estimates of the cost of antibiotic resistance are misleading and may result in inadequate investment in tackling the problem

Almost as soon as antibiotics were discovered, we knew that bacteria were able to develop resistance against them.1 This is not necessarily a problem, as long as there are other antimicrobials to take their place. During the latter half of the 20th century this was the predominant situation, but no longer.2 A rapid decrease in the number of new drugs approved and numerous withdrawals on quality and safety grounds have left the well dry, and it is clear that “the existing classes of antibiotics are probably the best we will ever have.”3

In light of this, there have been efforts to support interventions that encourage more conservative and appropriate use of antibiotics in an attempt to halt or slow the progress of resistance.4 However, this action is often too little and may be too late.

Given that the dangers of resistance are widely acknowledged, why isn’t more being done? One reason is that antibiotic resistance has fallen victim to evidence based policy making, which prioritises health problems by economic burden and cost effectiveness of interventions.5 Health economists have been unable to show that antibiotic resistance costs enough to be a health priority.

Limitations of health economic research

Ten years ago we published a systematic review on the economics of resistance.6 We asked two questions: what is the cost of resistance and what is the cost effectiveness of interventions to reduce it? The lack of research meant we could investigate only the second question.7 And even here we concluded that the evidence for the cost effectiveness of interventions for resistance was poor.

We have just performed a rapid review at the Department …

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