Antimicrobial resistance (AMR) is a growing global crisis – resistance to antibiotics is jeopardizing many of the advancements of modern healthcare. Governments and philanthropic organizations must collaborate to create the right conditions for private sector investments that will address AMR. Mobilizing the financial resources required to reduce deaths associated with AMR around the world could save more than 100 million lives by 2050. AMR not only makes infections harder to treat, but it also increases the risks associated with many medical procedures, including surgery and cancer care. Its drivers and consequences are exacerbated by poverty and inequality, making low- and middle-income countries the most vulnerable. Severe infections are the second-leading cause of death in cancer patients, and effective antibiotics are crucial in supporting patients undergoing cancer therapy. AMR also undermines the global agri-food system, leading to higher disease prevalence and mortality rates among animals, which in turn decreases productivity and increases costs for farmers.

The goal of this work is to review the available literature on the economic evaluation of AMR interventions, focusing on methods used to quantify the effects on AMR and the associated health consequences and costs. The current review extracted additional information to summarise the types and the key features of the AMR intervention economic evaluation literature available, that including thirty-one studies of which 18 evaluated interventions that aimed to reduce infection rates and 11 evaluated interventions that aimed to optimise antimicrobial use. Thirteen of 31 studies were cost-utility analyses. This review found limited available literature that mainly focused on high-income countries and infection prevention/reduction strategies. Most evaluations used a narrow study scope, which might have prevented the full capture of the costs and outcomes associated with interventions. Finally, despite the known complexities associated with quantifying AMR effects, and the corresponding methodological challenges, the implications of these choices were rarely discussed explicitly.

GSK announced that the 25^th March FDA has approved Blujepa (gepotidacin) for the treatment of female adults (≥40 kg) and paediatric patients (≥12 years, ≥40 kg) with uncomplicated urinary tract infections (uUTIs) caused by the following susceptible microorganisms: Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii complex, Staphylococcus saprophyticus and Enterococcus faecalis. Gepodaticin is a bactericidal, first-in-class triazaacenaphthylene antibiotic that inhibits bacterial DNA replication by a distinct binding site, a novel mechanism of action and for most pathogens, provides well-balanced inhibition of two different Type II topoisomerase enzymes. This provides activity against most target uropathogens (such as Escherichia coli and Staphylococcus saprophyticus), and Neisseria gonorrhoeae, including isolates resistant to current antibiotics. The approval is based on positive results from the pivotal phase III EAGLE-2 and EAGLE-3 trials which demonstrated non-inferiority to nitrofurantoin, one of the leading current standard of care options for uUTI, in female adults (≥40 kg) and paediatric patients (≥12 years, ≥40 kg) with a confirmed uUTI. In EAGLE-2, Gepotidacin demonstrated non-inferiority in therapeutic success which occurred in 50.6% (162/320) of participants compared to 47.0% (135/287) for nitrofurantoin (covariate-adjusted treatment difference 4.3%, 95% CI (-3.6, 12.1)). In EAGLE-3, Blujepa demonstrated statistically significant superiority versus nitrofurantoin (one-sided p-value 0.0003). Therapeutic success occurred in 58.5% (162/277) of participants compared to 43.6% (115/264) for nitrofurantoin (covariate-adjusted treatment difference 14.6%, 95% CI (6.4, 22.8)). The safety and tolerability profile of Blujepa in the EAGLE-2 and EAGLE-3 phase III trials was consistent with previous trials. US commercial launch is planned in 2H 2025.

This study estimates the cost of antibiotics if the costs of resistant infections are also considered. Community antibiotic dispensing data was collected from NHS Business Authority and linked to patients admitted to National Health Service (NHS) hospitals in England in 2019 with an infection that antibiotics are usually indicated for from Hospital Episode Statistics and bacterial infection episodes and antimicrobial susceptibility data from UKHSA’s Second Generation Surveillance Service. Preliminary results suggest that patients admitted to hospital that had an infection within 12 months of being prescribed an antibiotic are at an increased risk of antibiotic resistance compared to the general community. 0.6% of people prescribed an antibiotic are admitted to hospital with an infection within 12 months. Resistant infections are associated with an excess length of stay of 0.97 days compared to susceptible infections. There were almost 500,000 excess resistant infections in hospital admissions in patients that were prescribed antibiotics within the previous 12 months. The excess bed days for these infections cost the NHS approximately £162 million. Once fully developed, the AMR-adjusted cost of an antibiotic prescription could inform future health-economic assessments of stewardship interventions.

This study estimates the cost and clinical impact of IPC (infection prevention and control) measures on the spread of CPE (Carbapenemase-producing Enterobacterales) in hospitals. A stochastic, compartmental, dynamic mathematical model was developed to simulate the transmission of CPE in a typical UK hospital over five years. Preliminary results found that compared to no testing for CPE, culture testing all admissions decreased the total number of infections by 25% and was associated with a 2% increase in total hospital cost. Culture testing admissions that had previously been discharged positive in the past year resulted in a 5% decrease in infections compared to no testing, and a 0.2% reduction in costs. Culture testing all admissions with a previous inpatient attendance in the last year (including previous discharged positives) reduced infections by 7% and increased costs by 0.2%. Model predictions suggest that undertaking admission screening can considerably decrease CPE infections for relatively modest increases in costs, and that targeting this screening leads to more efficient and even cost-saving strategies.