The Public Health Agency has on behalf of the government investigated the costs and other consequences resulting from increased antimicrobial resistance in Sweden. According to our projections, the number of cases of resistance is expected to double in more than ten years. By 2050, the number of cases will be four times more than today. In total, this means an additional cost to society of approximately SEK 16 billion by 2050. The analysis is based on data of the notifiable antibiotic resistance and the development of these types of resistance in Sweden in recent years.
The report has been developed as part of a government commission to develop a model for health-economic calculations of the societal consequences resulting from antibiotic resistance. The assignment has been reported to the Ministry of Social Affairs on January 17, 2018.
In this Government commission the Public Health Agency of Sweden has calculated future direct health care costs, indirect costs and other consequences of antibiotic resistance in Sweden. The projections are based on simulations and refer to costs based on two time periods, up until the year 2030 and 2050 respectively. The analysis, which were conducted with a micro-simulation model, refers to notifiable antibiotic resistance and projections are based on actual data from 20122016.
In 2016 approximately 15,500 cases of notifiable antibiotic resistance were reported. According to our model, the simulation indicates that this number is estimated to be approximately 32,000 cases in 2030 and approximately 70,000 cases in 2050. Distributed per resistance type, ESBL and MRSA are increasing the most.
We have projected both the direct health care-associated and indirect costs for society. Direct costs are those which arise during treatment of antibiotic-resistant infections within health care and for contact tracing. The calculations are based on the assumption that current procedures for health care have not changed during the modelled time period. Indirect costs refer to those which are not directly linked to care for an individual. It may, for example, refer to higher costs for outbreak with spread of infection, changed treatment strategies or social costs in the form of loss of production during sickness absence.
Our simulation entails that the social costs of antibiotic resistance can be calculated to approximately SEK 4.3 billion up until 2030 and SEK 15.8 billion up until 2050. The cost of the final year 2030 is roughly SEK 400 million and for the year 2050 it is roughly SEK 600 million. The results are based on actual data on direct and indirect costs. We have refrained from performing calculations based on general estimates. Accordingly the report is based on safer data than several regularly cited international studies which were conducted previously. An interesting finding is also that the indirect costs for society, which tend to be cited as the greatest share (3, 4), appear to be significantly lower for Swedish conditions.
These amounts are slightly lower than in the Public Health Agency of Sweden's previous interim report. Which is due to the fact that simulations are based on development trends in two different time periods. In the previous interim report, when we estimated the development based on historical data, a linear trend was the most suitable, but in this report an exponential trend describes the resistance development of recent years in the best manner. For projections of the number of cases up until the year 2050, we have added restrictions in the model so that the final results are not unrealistically high, given what we know about other countries and the national development of the number of cases of resistance.
There are consequences and costs which we have not been able to analyse more in detail. The main reason for this is that there is a shortage of data. Instead we have reasoned about such factors in the report.
In an international perspective, Sweden has a favourable resistance situation, but the analysis shows that the problem is expected to increase significantly unless we face the development with effective countermeasures. The fact that the current situation is relatively good can, to a large degree, probably be attributed to the long term work which is performed in order to reduce the spread of infection within health care and reduce the resistance development through responsible antibiotic usage. The more than fourfold increase in only the notifiable cases which is predicted up until 2050 necessitates changed priorities and greater measures if the level of ambition is to be attained. The experience of other countries also shows that certain resistance types can spread quickly if the countermeasures are delayed.
In order to make better projections and simulate effects of interventions, the data of health care needs to be made more easily accessible. However, we can also state that in certain cases access to data which could provide a more complete view is completely missing.
Finally, this commission and report focus on the costs. Among all the figures and calculations, we cannot forget that infections caused by resistant bacteria almost double the risk of death resulting from the infection if it is serious. Or that patients who suffer from carrier status often feel stigmatised and in some cases are forced to undergo checks for a long time until they are free from the infection.