Older Americans were disproportionately affected by several different types of infection for which antibiotics were largely ineffective, resulting in nearly 12,000 deaths and costing the U.S. health care system almost $1.9 billion in 2017, a new study found.
Of those deaths, 40% were estimated to have occurred among those 65 years and older, while this same group of patients accounted for 41% of the associated health care costs. Yet Americans who are 65 years or older account for just 15% of the U.S. population, according to a corresponding analysis.
The study is the first to directly illustrate that so-called superbug infections — which do not respond to standard antibiotics – are especially severe and expensive to treat among seniors, a vulnerable population that also heavily relies on the taxpayer-funded Medicare program for much of their health care.
For this reason, the findings underscore the gravity of the systemic challenges posed by superbugs and the need to develop new antibiotics, explained David Hyun, who heads the antibiotic resistance project at The Pew Charitable Trusts and was a co-author of the study, published in Clinical Infectious Diseases. He noted that 80% of the deaths were contracted by seniors outside of hospitals or nursing homes.
“We know this age group is more vulnerable to infectious diseases, because their immunity goes down with age and they have more chronic medical conditions, all of which leads to worse [health] outcomes. And this [study] shows what happens after someone in this age group gets an infection,” Hyun told us.
“This is why we need to reduce inappropriate and unnecessary antibiotic use across all health care settings in order to buy us more time to slow the emergence of antibiotic resistance and, on the flip side, do anything we can to revitalize and fix the broken antibiotic pipeline.”
The study examined patients admitted to the U.S. Department of Veterans Affairs health care system between 2007 and 2018. After obtaining data on deaths and costs, the researchers calculated results for 2017, since that was the same year the Centers for Disease Control and Prevention used to examine outcomes in a 2019 report on antibiotic resistance.
The new study, which noted that 80% of the deaths in 2017 occurred among people who contracted antibiotic resistant infections outside of hospitals, also reviewed drug-resistant threats described in the CDC report. The agency had run cost analyses for six bacteria, and so the researchers sought to generate corresponding data to assess the effect on seniors.
The bacteria identified included two of the most urgent drug-resistant threats. One was acinetobacter, a group of germs that cause infections in the blood and urinary tract, as well as pneumonia. Another was enterobacteriaceae, a family of Gram-negative bacteria that includes a number of pathogens such as salmonella. Both types of bacteria are resistant to the carbapenem class of antibiotics.
Most of the infections, however, involved other serious threats, such as methicillin-resistant Staphylococcus aureus, or MRSA, which spreads both inside and outside health care facilities and can cause a range of illnesses, including pneumonia and infections of the skin and the bloodstream. Many recommended first-line drugs based on established practice guidelines no longer work.
The study arrives amid heightening concerns over antibiotic resistance. A report issued in 2016 by the U.K. government forecasted that drug-resistant infections may kill up to 10 million people a year by 2050. In the U.S., an estimated 35,000 people die of antibiotic-resistant infections annually, according to the CDC.
A recent World Health Organization report found that none of 43 antibiotics currently in development target the most dangerous bacteria. Meanwhile, new antibiotics are few and far between. Just 11 were approved since 2017, but nine of them offer limited benefits over existing treatments, since they belong to classes of medicines in which resistance has already taken hold.
The dearth of novel antibiotics is expected to take a toll in other ways. By 2050, the world could lose 1.1% of its annual gross domestic product due to drug-resistant infections, assuming the most optimistic scenario, according to a World Bank report issued in 2017. The GDP shortfall could exceed $1 trillion annually by 2030, but that could reach $3.4 trillion if resistance were to have a severe global impact.
Over the past decade, several large drug makers left the market and, more recently, some small players have withdrawn or failed. These developments reflect what industry experts say is a lack of sufficient incentives to ensure small companies can generate sales and profits. Between 200 and 300 very small companies worldwide now conduct the vast majority of research work.
Recently, nearly two dozen large drug makers pledged $1 billion to create the AMR Action Fund with plans to acquire or invest in small companies that can develop two to four novel antibiotics by 2030. The effort has backing from the World Health Organization and the European Investment Bank, although experts say the output will not be sufficient by itself.
To turn the tide, public health experts and small companies are encouraging governments to explore different types of incentives to encourage development. One approach is called a push incentive, which is essentially a subsidy or grant designed to help accelerate research, development, and regulatory approval by making it less expensive for companies to create new and novel antibiotics.
Another approach is called a pull incentive which involves a subscription-style business model of the sort outlined in a bill recently introduced in Congress called The Pasteur Act. The intent is to provide a stable base of revenue that can give companies and their investors enough confidence that a market will exist once an antibiotic is approved by the Food and Drug Administration.
The legislation would provide up to $11 billion, including $500 million for stewardship programs that guide the appropriate use of antibiotics. The bet is that such a large sum would entice more investors to bankroll small companies to develop novel antibiotics and then win regulatory approval. At the end of the day, the lawmakers hope the funding will yield anywhere from five to seven useful therapies.
Meanwhile, Pew suggested that the Centers for Medicare & Medicaid Services should adopt policies that provide incentives for tracking antibiotic use and resistance data, and also reporting the information to public health authorities. Another idea: the agency should develop and implement quality measures around antibiotic prescribing and resistance in nursing homes.
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