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Executive summary
Antimicrobial resistance (AMR) poses a significant threat to global health and economic stability. This report integrates human health burden projections with economic models to provide a comprehensive analysis of the impact of AMR on global economies and health systems.
Key messages
We estimate that:
1. The impact of antimicrobial resistance falls most heavily on low- and lower-middle-income countries. Antimicrobial resistance increases the cost of health care by US$ 66 billion, and this will rise to US$ 159 billion in our business-as-usual scenario where resistance rates follow historical trends.
2. If resistance rates increased at the rate of the bottom 15% of countries, AMR health costs would rise to US$ 325 billion and the global economy would be US$ 1.7 trillion smaller in 2050 (compared to the business-as-usual scenario).
3. If high quality treatment is provided to everyone with bacterial infections and funding innovative new antibiotics, this would mean that by 2050:
- Health costs could be US$ 97 billion cheaper.
- The economy could be US$ 960 billion larger.
- Generated health benefits could be worth US$ 680 billion to countries.
4. Improving innovation and access to high quality treatment would cost about US$ 63 billion per year, offering a global return on investment of 28:1.
Methodology
We adopted a multifaceted approach to estimate the economic burden of AMR. Projections of the health burden were taken from the Institute for Health Metrics and Evaluation (IHME) and five aspects of their economic impact were quantified:
- Health care costs: A literature review identified cost estimates for treating resistant infections across 204 countries. We adopted a cost-of-illness methodology, mapping costs to 11 infectious syndromes, and used an imputation model to estimate costs for unknown countries, combining them with inpatient estimates derived from IHME data to project future costs.
- Economic resilience: We conducted a literature review to understand the likely ways that changes in resistance might affect the economy. We then estimated how changes in AMR would lead to changes in population, direct and indirect labour force participation, tourism and hospitality. Our estimates were derived from literature reviews, mathematical modelling and expert elicitation from 21 experts.
- Macroeconomic modelling: We fed health and resilience inputs into a computable general equilibrium (CGE) model to simulate the wider impact on the economy.
- Intervention costs: We used literature reviews and economic modelling to estimate the cost of various interventions that could tackle AMR, allowing us to compare costs and benefits.
- Gross domestic product- (GDP) based health valuation: We estimated the health loss due to AMR, converting it into a monetary value using an established methodology.
Results
Effect of AMR on mortality
All estimates of the health burden of AMR come from the IHME. Five of these scenarios were examined and compared with a business-as-usual scenario in which AMR resistance follows trends since 1990:
- Business-as-usual scenario: this assumes that resistance follows historical trends.
- Scenario 1: better treatment of bacterial infections is provided.
- Scenario 2: increased innovation and rollouts of gram-negative antibiotics.
- Scenario 3: better treatment and increased innovation is provided (combining scenarios 1 and 2).
- Scenario 4: improved access to treatments for bacterial infections; increased innovation for gram-negative bacteria; and improved access to vaccines, sanitation and clean water.
- Scenario 5 (accelerated rise in resistance scenario): this assumes resistance increases at the rate of the bottom 15% of countries.
Health burden estimates from the IHME suggest that if resistance follows trends since 1990 (the business-as-usual scenario), AMR will lead to 38.5 million deaths between 2025 and 2050. Scenario 1 would avert 90 million deaths over this period (the vast majority not from resistant infections), Scenario 2 would avert 10 million deaths, Scenario 3 would avert 100 million deaths and Scenario 4 would avert 110 million deaths. In the accelerated rise in resistance scenario (Scenario 5), an additional 6.7 million people would die as a result of AMR.
Effect of AMR on the economy
We estimate the current direct health care costs associated with AMR at US$ 66 billion per year (0.7% of global health expenditures). These costs encompass the cost of treating antibiotic-resistant infections.
The median cost of treating a resistant infection per hospital admission varies significantly, ranging from US$ 100–30,000 depending on a country’s income level and the type of infection. Costs per incidence are highest in high-income countries, where more intensive treatment protocols are available, and lowest in low-income countries, where resources are highly constrained.
If resistance rates follow historical trends since 1990, the direct health care costs of AMR are projected to rise to US$ 159 billion per year by 2050 (1.2% of global health expenditure). This increase is attributed to higher treatment intensities and economic growth in regions most affected by AMR.
If nobody died from AMR, we would expect the global population to be 22.2 million larger by 2050 than it would be in a world in which resistant infections follow historical trends. This increase would add 8 million people to the labour force. Most experts consulted for this study agreed that AMR would reduce tourism and hospitality, with poorer countries particularly vulnerable and countries with robust health systems and higher GDPs more resilient. Experts also noted that relative AMR rates are crucial, as higher rates in specific countries would deter tourism more than global rates rising at a uniform rate.
Results of intervention scenarios
Effects of the five IHME scenarios were examined, and the results are summarised in Table E.1.
Table E.1 Deaths averted, health care cost savings, macroeconomic benefits and a GDP-based health valuation in 2050 under five AMR scenarios (in billion US$ at 2022 value, except where otherwise indicated)
Scenario |
Deaths avoided 2025–50 (millions) |
Health care costs saved |
Change in GDP |
GDP-based health valuation |
---|---|---|---|---|
Scenario 1: better treatment of bacterial infections |
89.84 |
19.17 |
269.16 |
506.52 |
Scenario 2: innovation and rollout of effective new gram-negative antibiotics |
10.23 |
83.28 |
742.85 |
174.06 |
Scenario 3: better treatment and innovation |
100.01 |
96.67 |
959.32 |
678.94 |
Scenario 4: combined interventions |
110.02 |
98.62 |
989.70 |
875.76 |
Scenario 5: accelerated rise in resistance scenario
|
-6.69 |
-175.74 |
-1,671.16 |
-264.85 |
Note: Data for deaths avoided are from Vollset et al. (2024).
Lower- and middle-income countries stand to gain the most from policies that combat AMR (see Figure E.1).
Figure E.1 Percent and total GDP impact in 2050 due to improved treatment and innovation (in billion USD)
Better treatment of bacterial infections
Improving treatment for bacterial infections, for example by providing better access to antibiotics, could lead to a US$ 19 billion annual reduction in health care costs by 2050 (a saving of 0.12%). This scenario would increase global GDP by US$ 269 billion (0.13%) over the business-as-usual scenario. The health benefits from this intervention would be worth half a billion dollars if disability-adjusted life years (DALYs) are valued at the GDP per capita of a given country.
Increased innovation and the rollout of effective new gram-negative antibiotics
Gram-negative bacteria cause about two-thirds of the world’s bacterial burden and tend to be more difficult to treat than gram-positive pathogens. Most of the priority areas for new antibiotics are gram-negative (Breijyeh et al., 2020). Introducing new gram-negative antibiotics could reduce health care costs by US$ 84 billion (0.54%) per year by 2050. This scenario would generate improved health outcomes worth US$ 174 billion, using a GDP-based health valuation, and would add US$ 740 billion (0.37%) to global GDP. This underscores the critical need for investment in antibiotic research and development (R&D).
Better treatment and increased innovation
Improving antibiotic access and introducing new antibiotics could result in significant cost savings, potentially reducing health care expenditures by US$ 97 billion (0.63%) per year by 2050. Including wider macroeconomic benefits would see GDP increase by US$ 960 billion (0.47%) per year by 2050. This scenario demonstrates the compounded benefits of integrating multiple interventions to combat AMR.
Combined interventions
A comprehensive approach that combines better treatment of bacterial infections, the introduction of new antibiotics, enhanced vaccination programmes and better access to WASH would result in the largest reduction in health care costs, saving up to US$ 99 billion (0.64%) per year by 2050. This scenario would add almost US$ 960 billion (0.47%) per year to global economic output.
Accelerated rise in resistance scenario
Without effective interventions, health care costs could increase by US$ 176 billion (1.14%) per year by 2050, and global output could be US$ 1.7 trillion (0.83%) lower than in the business-as-usual scenario.
Cost of interventions and return on investment
Both improved treatment for and increased access to antibiotics significantly improve health outcomes. It is also cost-effective to roll out both types of interventions.
There is no consensus on the number of new antibiotics needed, with estimates ranging from 6 to 15 drugs per decade. We assume that ten are needed per decade and that two-thirds will be for gram-negative antibiotics. With estimated R&D costs of US$ 3.3 billion per drug, this leads to an annual additional R&D cost of US$ 2.2 billion. If all high-income countries funded this R&D in proportion to their GDP, it would cost them 0.0036% of GDP in 2025. We project these costs to rise slightly more rapidly than inflation, but the cost for each country would decrease over time as more countries join the ranks of high-income countries.
For these new drugs to provide the promised health benefits, people across the world must have access to them. We estimate that it would cost US$ 59 billion to ensure that all countries have outcomes for bacterial infections that match the quality of treatment currently available in the 85th percentile of countries. Adding this to the R&D cost yields a global estimate of US$ 63 billion – less than the reduction in health costs that would accrue from implementing these interventions. When the macroeconomic and health benefits are considered, the return on investment (ROI) is 28:1, highlighting the excellent value for money these interventions offer (Figure E.2).
Figure E.2 Estimated annual costs (in US$) and benefits in 2050 of better treatment for bacterial infections and innovative new gram-negative drugs
Read the full report here.
This report is part of the EcoAMR series. The series is produced by a consortium of international partners including the Center for Global Development, the World Organisation for Animal Health, the Institute for Health Metrics and Evaluation, RAND Europe, Animal Industry Data, and the World Bank.
Other publications in the series include:
- Forecasting the Fallout from AMR: Economic Impacts of Antimicrobial Resistance in Food-Producing Animals, https://doi.org/10.20506/ecoAMR.3541
- Forecasting the Fallout from AMR: Human Health Impacts of Antimicrobial Resistance, https://doi.org/10.20506/ecoAMR.3540
- Forecasting the Fallout from AMR: Averting the Health and Economic Impacts through One Health Policy and Investment, https://doi.org/10.20506/ecoAMR.3544
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