Modified: 26.06.2008  
 
































home » Objectives

Objectives / Methodology / Work Packages


General objective


The general objective of this project is to provide realistic estimates of the burden of disease and the costs attributable to infections caused by antimicrobial resistant pathogens in Member States and Accession Countries of the European Union.

The strategic goals pursued in the general objective are:

  1. To provide valid data for politicians, policy-makers and public health experts that will allow informed estimates of the burden and the costs of AMR on a national level
  2. To allow a comparison of costs between countries of the European Region.
  3. Recommendations for participating countries/hospitals for implantation effective measures to keep costs caused by AMR to a minimum.
  4. To inform public health authorities throughout Europe, in order to prioritise and plan future health political goals, as against other specific causes of morbidity and mortality in Europe.

Specific objectives

  1. To identify on a country-by-country basis the information needs of different stakeholders (public health experts, policy makers, politicians, health care system managers) for their own assessment of the burden of infectious diseases caused by antimicrobial susceptible and resistant bacterial pathogens
  2. To generate country-specific cost models for quantifying the economic loss due to AMR
  3. To identify incentives and counterincentives that impinge on efforts to control the spread of AMR
  4. To determine the excess mortality, morbidity, length of stay and costs attributable to AMR on the basis of calculations made from data gathered in approximately 15 hospitals and 200 ICUs in different European countries (incl. the influence of delay in appropriate therapy)
  5. To identify best infection control practices and antimicrobial drug use programmes to keep costs caused by AMR to a minimum
  6. To provide direct feedback on the individual performance of the participating hospitals
  7. To forecast trends of AMR by extrapolating data available over the last six years for participating countries participating in EARSS and HELICS/IPSE
  8. To illustrate the financial impact of AMR on care in European hospitals; besides this, to estimate the human and societal dimensions of infections caused by resistant pathogens and the repercussions for the health care systems, e.g. loss of confidence in hospitals

Methodology

BURDEN will proceed through a five-step process:

  1. The information needs of stakeholders (i.e. general public, patients, doctors, hospital administration, national health system managers and politicians) will be identified with respect to the resistance situation in participating European countries.
  2. Through a detailed understanding of the national reimbursement and costing strategies, country-specific cost models will be designed and incentives and counter incentives impinging on efforts to control the spread of AMR will be identified.
  3. The prolongation of treatment and hospital stay, as well as time off-work after hospital discharge and mortality will be ascertained by follow-up of patients with blood stream infections caused by resistant (cases) and a cohort of controls in collaborating hospitals. Collaborating hospitals will be identified in Member States of the European Community and the Accession Countries. These hospitals also participate in the European Antimicrobial Resistance Surveillance System (EARSS) and regularly report resistance proportions to a central data-base. Their laboratories determine antimicrobial susceptibility according to national or international standards and are regularly audited by annual external quality assurance exercises carried out by the United Kingdom National External Assurance System (UK-NEQAS). Indicator organisms (and indicator resistance phenotypes) for this proposal will include S. aureus (MRSA), and E. coli (ESBL-producers and fluoroquinolone-resistant). A detailed list of patient characteristics (demographic variables, co-morbidities, disease severity scores and length of hospitalization before blood stream infection) that may confound the study outcome (length of hospital stay, and time off-work and mortality) will be identified on enrolment and used during analysis for appropriate stratification. Average excess costs per case will be determined using proportional hazard methods for competing risks. Standardized global costs incurred by antimicrobial-resistant blood stream infections will be determined on the basis of the national cost models and the national distribution of AMR in hospitals collected through the EARSS network.
  4. Mathematical models of AMR data will allow predictions on how direct costs incurred by AMR will develop in participating countries over the next five years. Estimates will be based on the trend analysis of the EARSS data-base.
  5. Finally, a descriptive study will be carried out on experiences with and outcomes of infections caused by antimicrobial resistant pathogens with regards to changes in the quality of life, incorporating information from patients and care givers through semi-structured questionnaires and interviews. This study should also identify threats to public confidence in health care delivery systems through a systematic survey among patients and care givers.

Work Packages

WP 1: Project Coordination

WP 2: Dissemination of the results

WP 3: Evaluation of the project

WP 4: Identification of needs

WP 5: Case studies of the burden of AMR

WP 6: Impact of AMR and appropriate treatment in ICU-acquired infections

WP 7: Analytical study; Burden of resistance and infectious disease

WP 8: Mathematical model
   

home » Objectives

Objectives / Methodology / Work Packages


General objective


The general objective of this project is to provide realistic estimates of the burden of disease and the costs attributable to infections caused by antimicrobial resistant pathogens in Member States and Accession Countries of the European Union.

The strategic goals pursued in the general objective are:

  1. To provide valid data for politicians, policy-makers and public health experts that will allow informed estimates of the burden and the costs of AMR on a national level
  2. To allow a comparison of costs between countries of the European Region.
  3. Recommendations for participating countries/hospitals for implantation effective measures to keep costs caused by AMR to a minimum.
  4. To inform public health authorities throughout Europe, in order to prioritise and plan future health political goals, as against other specific causes of morbidity and mortality in Europe.

Specific objectives

  1. To identify on a country-by-country basis the information needs of different stakeholders (public health experts, policy makers, politicians, health care system managers) for their own assessment of the burden of infectious diseases caused by antimicrobial susceptible and resistant bacterial pathogens
  2. To generate country-specific cost models for quantifying the economic loss due to AMR
  3. To identify incentives and counterincentives that impinge on efforts to control the spread of AMR
  4. To determine the excess mortality, morbidity, length of stay and costs attributable to AMR on the basis of calculations made from data gathered in approximately 15 hospitals and 200 ICUs in different European countries (incl. the influence of delay in appropriate therapy)
  5. To identify best infection control practices and antimicrobial drug use programmes to keep costs caused by AMR to a minimum
  6. To provide direct feedback on the individual performance of the participating hospitals
  7. To forecast trends of AMR by extrapolating data available over the last six years for participating countries participating in EARSS and HELICS/IPSE
  8. To illustrate the financial impact of AMR on care in European hospitals; besides this, to estimate the human and societal dimensions of infections caused by resistant pathogens and the repercussions for the health care systems, e.g. loss of confidence in hospitals

Methodology

BURDEN will proceed through a five-step process:

  1. The information needs of stakeholders (i.e. general public, patients, doctors, hospital administration, national health system managers and politicians) will be identified with respect to the resistance situation in participating European countries.
  2. Through a detailed understanding of the national reimbursement and costing strategies, country-specific cost models will be designed and incentives and counter incentives impinging on efforts to control the spread of AMR will be identified.
  3. The prolongation of treatment and hospital stay, as well as time off-work after hospital discharge and mortality will be ascertained by follow-up of patients with blood stream infections caused by resistant (cases) and a cohort of controls in collaborating hospitals. Collaborating hospitals will be identified in Member States of the European Community and the Accession Countries. These hospitals also participate in the European Antimicrobial Resistance Surveillance System (EARSS) and regularly report resistance proportions to a central data-base. Their laboratories determine antimicrobial susceptibility according to national or international standards and are regularly audited by annual external quality assurance exercises carried out by the United Kingdom National External Assurance System (UK-NEQAS). Indicator organisms (and indicator resistance phenotypes) for this proposal will include S. aureus (MRSA), and E. coli (ESBL-producers and fluoroquinolone-resistant). A detailed list of patient characteristics (demographic variables, co-morbidities, disease severity scores and length of hospitalization before blood stream infection) that may confound the study outcome (length of hospital stay, and time off-work and mortality) will be identified on enrolment and used during analysis for appropriate stratification. Average excess costs per case will be determined using proportional hazard methods for competing risks. Standardized global costs incurred by antimicrobial-resistant blood stream infections will be determined on the basis of the national cost models and the national distribution of AMR in hospitals collected through the EARSS network.
  4. Mathematical models of AMR data will allow predictions on how direct costs incurred by AMR will develop in participating countries over the next five years. Estimates will be based on the trend analysis of the EARSS data-base.
  5. Finally, a descriptive study will be carried out on experiences with and outcomes of infections caused by antimicrobial resistant pathogens with regards to changes in the quality of life, incorporating information from patients and care givers through semi-structured questionnaires and interviews. This study should also identify threats to public confidence in health care delivery systems through a systematic survey among patients and care givers.

Work Packages

WP 1: Project Coordination

WP 2: Dissemination of the results

WP 3: Evaluation of the project

WP 4: Identification of needs

WP 5: Case studies of the burden of AMR

WP 6: Impact of AMR and appropriate treatment in ICU-acquired infections

WP 7: Analytical study; Burden of resistance and infectious disease

WP 8: Mathematical model