Estimating Economic Costs Associated with Treating Antimicrobial-Resistant Infections in Humans in Malawi.
9 affiliations
- 1Health Systems and Policy Department, Kamuzu University of Health Sciences, Blantyre 312200, Malawi.
- 2Children Foundation Malawi, Monitoring and Evaluation Department, Baylor College of Medicine, Balaka 302100, Malawi.
- 3Fondazione IRCCS Policlinico San Matteo di Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy.
- 4Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
- 5School of Veterinary Medicine, University College Dublin, D04 V1W8 Dublin, Ireland.
- 6Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
- 7Pathology Department, Kamuzu University of Health Sciences, Blantyre 312200, Malawi.
- 8Institute for Public Health & Hygiene, University Hospital Bonn, 53127 Bonn, Germany.
- 9Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
Abstract
Background
Antimicrobial resistance (AMR) poses a significant threat to global health and economic development. In Malawi, the economic costs associated with the treatment of AMR infections remain largely unknown which may hinder resource allocation and policy prioritization.Method
The study used a cross-sectional design and was conducted between September 2023 and January 2025 at three different hospital settings. Data were collected from inpatients with laboratory-confirmed urinary tract infection (UTI) or blood stream infection (BSI). Additional follow-up data were collected from patients for four weeks post discharge. We analyzed patient level data first using descriptive statistics and employed an instrumental variable 2-stage least squares regression to estimate drivers of AMR treatments costs.Results
A total of 610 patients participated in the study. Of these, 45% had AMR-associated resistant infections. Overall, E. coli (43%) followed by P. aeruginosa (22%), K. pneumoniae (14%), and S. aureus (10%) were the most common pathogens. UTI was marginally more common (51%) compared to BSI (49%). BSI had a higher average cost than UTI for patients with both susceptible and resistant infections. On average, a patient spent MK283,815.10 (US$163.71) ranging from zero to MK13,500,000 (US$7786.90). Patients with resistant infections incurred, on average, MK161,785 (US$93.32) more than patients with susceptible infections, largely driven by prolonged hospitalization among other factors. Overall, the direct medical observed costs averaged MK37,165.29 (US$21.44) while direct non-medical observed costs averaged MK61,908.71 (US$35.71). Productivity losses for the patient and guardian(s) were a major observed cost averaging MK160,322.80 (US$92.49). The regression results further showed that having a bank account as a proxy of wealth, non-farm business, longer travel duration, BSI, and K. pneumoniae as the causative pathogens were significantly associated with increased cost burden among the patients.Conclusions
AMR-associated infections impose substantial economic burden on patients and households. Further strengthening of AMR surveillance and stewardship are needed as critical elements of Malawi's National Action Plan. However, measures should also be taken to mitigate the economic consequences related to AMR, especially for patients who bear the brunt of these costs for lack of financial protection in Malawi's health system.
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BibTeX
@article{masoambeta2026estimating,
title = {{Estimating Economic Costs Associated with Treating Antimicrobial-Resistant Infections in Humans in Malawi.}},
author = {Edward B Masoambeta and Ganizani Nansongole and Luigia Scudeller and Tomislav Kostyanev and Finola Leonard and Fiammetta Bozzani and Eric Umar and Chisomo L Msefula and Chantal M Morel and Jobiba Chinkhumba},
journal = {Tropical medicine and infectious disease},
year = {2026},
month = sep,
doi = {10.3390/tropicalmed11100276},
url = {https://europepmc.org/article/MED/42931461},
note = {CC BY},
}
RIS
TY - JOUR
TI - Estimating Economic Costs Associated with Treating Antimicrobial-Resistant Infections in Humans in Malawi.
AU - Edward B Masoambeta
AU - Ganizani Nansongole
AU - Luigia Scudeller
AU - Tomislav Kostyanev
AU - Finola Leonard
AU - Fiammetta Bozzani
AU - Eric Umar
AU - Chisomo L Msefula
AU - Chantal M Morel
AU - Jobiba Chinkhumba
PY - 2026
DA - 2026/09/30
JO - Tropical medicine and infectious disease
DO - 10.3390/tropicalmed11100276
UR - https://europepmc.org/article/MED/42931461
AB - Background Antimicrobial resistance (AMR) poses a significant threat to global health and economic development. In Malawi, the economic costs associated with the treatment of AMR infections remain largely unknown which may hinder resource allocation and policy prioritization.Method The study used a cross-sectional design and was conducted between September 2023 and January 2025 at three different hospital settings. Data were collected from inpatients with laboratory-confirmed urinary tract infection (UTI) or blood stream infection (BSI). Additional follow-up data were collected from patients for four weeks post discharge. We analyzed patient level data first using descriptive statistics and employed an instrumental variable 2-stage least squares regression to estimate drivers of AMR treatments costs.Results A total of 610 patients participated in the study. Of these, 45% had AMR-associated resistant infections. Overall, E. coli (43%) followed by P. aeruginosa (22%), K. pneumoniae (14%), and S. aureus (10%) were the most common pathogens. UTI was marginally more common (51%) compared to BSI (49%). BSI had a higher average cost than UTI for patients with both susceptible and resistant infections. On average, a patient spent MK283,815.10 (US$163.71) ranging from zero to MK13,500,000 (US$7786.90). Patients with resistant infections incurred, on average, MK161,785 (US$93.32) more than patients with susceptible infections, largely driven by prolonged hospitalization among other factors. Overall, the direct medical observed costs averaged MK37,165.29 (US$21.44) while direct non-medical observed costs averaged MK61,908.71 (US$35.71). Productivity losses for the patient and guardian(s) were a major observed cost averaging MK160,322.80 (US$92.49). The regression results further showed that having a bank account as a proxy of wealth, non-farm business, longer travel duration, BSI, and K. pneumoniae as the causative pathogens were significantly associated with increased cost burden among the patients.Conclusions AMR-associated infections impose substantial economic burden on patients and households. Further strengthening of AMR surveillance and stewardship are needed as critical elements of Malawi's National Action Plan. However, measures should also be taken to mitigate the economic consequences related to AMR, especially for patients who bear the brunt of these costs for lack of financial protection in Malawi's health system.
SN - 2414-6366
ER -