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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 of Health's request to take into account newer information on the first question. The box summarises our methods and further details are available in the full report. 8 Estimates of additional cost varied from less than $5 (£3; €4) to more than $55000 per patient episode. This might be explained by type of resistance and how productivity losses are dealt with.
Box 1 Methods used in the review 8
We searched for the combinations of terms relating to resistance, antimicrobial and costs. Some papers did not refer to antimicrobial resistance generally but only to particular drugs or...