Attributable societal cost of antimicrobial resistance in Ghana: A microsimulation study focusing on socio-demographic groups

Background: Investment case for antimicrobial resistance (AMR) is needed to stimulate the willpower of national governments to invest in AMR mitigation. Objective: We performed a microsimulation analysis predicting the potential societal cost savings for reducing the prevalence of AMR in Ghana. Methods: This study combined bacterial resistance epidemiology and cost data from Ghana to perform a microsimulation analysis focusing on socio-demographic groups, predicting the potential societal cost savings should Ghana mitigate AMR. Case definition was enterobacterial 3GC resistant infections, methicillin-resistant staphylococcus aureus (MRSA), and multi-drug-resistant mycobacterial tuberculosis. Costs were calculated under a business-as-usual scenario considering a 2% annual population growth rate, 5% discount rate for future costs, age-specific resistant risk profile, and a seven-year time horizon from 2024 to 2030. We reported the cost in purchasing power parity equivalent in international United States dollars, adjusting for mortality, age groups, gender, and wealth quintile. Results: Using 0.124 and 0.109 resistant probability risk between females and males, we predicted almost 78,000 annual AMR infections and about 6,300 attributable deaths. MRSA and 3GC resistant infections made up 20.2% and 79.2% of the predicted annual infections, corresponding to an estimated mean societal cost of about USD 435 million. In decreasing order of magnitude, the estimated mean annual cost of productivity loss due to AMR-attributable mortality accounted for 40.6% of the mean annual societal cost, followed by the cost to healthcare providers (24.1%), direct medical cost to patients and caregivers (22.4%), productivity loss for surviving patients and caregivers (10.4%), and direct non-medical costs to patients and caregivers (2.6%). Resistant infections in under-five children and persons above 60 years contribute 48.2% and 26.9% of the estimated annual societal cost, respectively. Except for the number of resistant infections, the estimated mean annual costs between wealth quintile groups were significantly different (p=0.03) due to differences in productivity costs between wealth quintile groups. Conclusion. The study shows that AMR-attributable societal cost implications are enormous, requiring a concerted effort by society to mitigate the development and spread of AMR organisms.