Antimicrobial resistance (AMR) jeopardises the effectiveness of many of the most valuable medical and public health advances achieved in the twentieth century. It occurs when the microbes that cause disease evolve so that the medicines which used to kill them no longer work. In 2016, the high-level meeting of United Nation’s General Assembly acknowledged AMR as a fundamental threat to the health of populations, the global economy and society as a whole. It also highlighted the need for countries to urgently put in place policies to tackle AMR and prevent its disastrous consequences.

Around 2.4 million people could die in Europe, North America and Australia between 2015-2050 due to superbug infections unless more is done to stem antibiotic resistance. However, three out of four deaths from superbug infections could be averted by spending just USD 2 per person a year on measures as simple as handwashing and more prudent prescription of antibiotics. A short-term investment to stem the superbug tide would save lives and money in the long-run.

Antimicrobial resistance (AMR) is a large and growing problem with the potential for enormous health and economic consequences, globally. As such, AMR has become a central issue at the top of the public health agenda of OECD countries and beyond. This chapter brings together the main messages of this publication and describes the key policy implications from new OECD analyses on the health and economic burden of AMR and on innovative actions to fight this top public health issue. The chapter presents AMR trends and projections in 52 OECD, Group of Twenty (G20) and European Union (EU) countries and makes a strong economic case to upscale investments in policies to promote prudent use of antibiotics in the human health sector and in policies to prevent the spread of infections. The chapter concludes by presenting the expected effectiveness, impact on healthcare expenditure and cost-effectiveness of such policies in 33 OECD and EU countries.

This chapter introduces the background and history of antimicrobial resistance (AMR) including its biological underpinnings. It offers a comprehensive look at the leading causes and consequences of AMR. It highlights the multi-sectorial aspects of resistance development and spread and describes antibiotic use and misuse across a range of sectors. The chapter then provides a framework for understanding how AMR develops and leads to infections and provides intervention targets aimed to disrupt this process. Finally, the chapter concludes by highlighting the need for multi-sectorial and multi-national solutions. This chapter provides the reader with the foundation for the following analytical chapters.

Antimicrobial resistance (AMR) proportions have evolved very differently across countries and antibiotic-bacterium combinations in the last decade. This chapter looks at the challenges involved in defining and measuring resistance internationally, along with the methodology used to estimate historic and future resistance proportions. The chapter presents predicted resistance proportions for 52 countries for 2015, along with the rate of change since 2005 (averaged across eight priority antibiotic-bacterium pairs). The chapter then provides data on the projected resistance proportions across the same countries up to 2030. Factors contributing to the wide variability in the predicted resistance proportions between antibiotic-bacterium pairs within and across different countries are explored. The chapter concludes by looking at the problem of increasing resistance to second and third-line antimicrobials and highlights steps needed to achieve better empirical research and more targeted policy actions.

Antimicrobial resistance (AMR) is a major public health concern worldwide. The OECD has developed a micro-simulations model to produce comparable cross-country estimates of the health and economic impact of AMR, for a comprehensive set of infections susceptible to develop resistance. Individual analyses were performed for 33 OECD and European Union/European Economic Area (EU/EEA) member countries. The model estimates for the included countries show that the current burden of AMR is substantial but, at this point, still limited in comparison to the impact of other conditions. This chapter provides an overview of current economic studies on AMR, describes the findings of the main analyses, along with the major knowledge gaps in the current economic literature on AMR. The characteristics and results of the OECD AMR microsimulation model are then presented, followed by the results of a second analysis conducted by the OECD, focusing specifically on the potential health burden of AMR in the context of antimicrobial prophylaxis treatments. The final section of this chapter summarises the main findings and discusses their policy implications.

During the last few years, there has been a growing interest in developing and implementing policies to combat the spread of antimicrobial resistance (AMR). This chapter provides an overview of the current status of OECD, Group of Twenty (G20) and European countries’ action plans for tackling AMR and highlights the critical need for extensive international collaboration among all stakeholders. It looks at varied policy options to promote the prudent use of antimicrobials, stop the spread of infections, and prevent infections all together. Actions such as antimicrobial stewardship programmes, improved environmental hygiene, and vaccination use are examined and their effectiveness illustrated in a variety of contexts. The chapter describes some of the implementation decisions and challenges associated with these interventions, and where possible, addresses the degree to which these policies have been adopted globally.

The impact of antimicrobial resistance (AMR) on health and health systems expenditure is substantial and set to increase dramatically if no action is taken to curb current trends. Existing AMR control policies have the potential to significantly influence the burden of AMR through first reducing the risk of transmission of infections or by reducing the inappropriate prescription and use of antimicrobials. This chapter reports the findings of a cost-effectiveness model developed to assess and compare the health and economic impact of a number of AMR control policies relative to a business-as-usual scenario in which there are no interventions. The OECD SPHeP-AMR model was used to assess performances of six selected policies – stewardship programmes, improved hand hygiene, enhanced environmental hygiene, rapid diagnostic tests, delayed prescriptions and mass media campaigns – if they were scaled up to national levels in 33 countries. The effects of each AMR control policy on health outcomes and health care expenditure for the 33 countries included in the microsimulation are presented, along with the possible impact of combining different policies. Finally, the strengths and weaknesses of the findings and sensitivity analysis of the main outcomes are discussed.