Estimating the global economic costs of antifungal resistance
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What is the issue?
Fungal pathogens are responsible for at least 13 million infections and 1.5 million deaths globally annually. The clinical disease burden is particularly high among patients with compromised immune function for whom infections can rapidly become severe, resulting in high morbidity and mortality. The severity of fungal infections ranges from relatively mild superficial infections (affecting nails, skin, and mucous membranes) to severe infections affecting the lungs, urinary tract, or brain, which are associated with potentially life-threatening complications.
Antifungal resistance (AFR) occurs when fungal infections no longer respond to existing medicines, making treatment challenging. While antimicrobial resistance, including antifungal resistance, is a naturally occurring phenomenon, inappropriate use of antifungals in human health, animal health, and the food system, the use of fungicides in the environment, and climate change all contribute to it. Trends in the emergence of antifungal resistance have caused concerns among public health stakeholders as a rising global threat. Despite these concerns, fungal infections have often been neglected in public health considerations and public health research funding. The slow pace of research and development for new antifungals to treat pathogens that have developed resistance to existing medicines and the lack of vaccines for fungal infections points to the urgent need to both support R&D and take action to address resistance.
How are we helping?
RAND Europe has been tasked to estimate the current and future cost of antifungal resistance in the global economy between 2025 and 2050 with the aim to highlight the potential economic risks of no further action to tackle the issue of AFR.
As no one can predict the future with certainty, the idea of this kind of research is to apply the best possible data and corresponding assumptions to predict how the global economy would perform with or without further policy action in relation to fungal infections. The aim is to provide decision-makers with a tool to understand how considerable the potential economic risk is and whether investing in the issue is worthwhile considering competing interests from other public sector investments such as defence and security, infrastructure or transportation.
We will use our multi-region dynamic computable general equilibrium (DCGE) model to understand these economic risks. This model conceptualises the economies of various countries as open economies connected to the rest of the world through trade (e.g. intermediate and final goods and services) and investment interlinkages. DCGE models consider health as an element of human capital, a productive asset within an economy (e.g. improvements in health leading to a larger labour supply, better productivity outcomes, which can raise the income levels of households, etc.). Analysis in DCGE models follows a ‘comparative static’ approach, where we want to discover what happens if changes to (policy) parameters are introduced as exogenous ‘shocks’ to the model. Then we compare a ‘post-changes’ counterfactual equilibrium against a baseline or benchmark equilibrium.
To build the model, beyond the underlying economic and demographic input data, we require information on incidence of fungal infections, mortality risk, morbidity risk, resistance rates by pathogen, AFR-attributable mortality risk and AFR-attributable morbidity risk. We will carry out a rapid evidence assessment (REA) to identify data sources and parameter values. The study will focus on pathogens identified as the most critical and associated with a relatively large clinical burden and we will look at all world regions, including low- and middle-income countries. Once we have collected data on parameters needed to build the model, we will proceed with the economic model conceptualisation to build the scenarios and estimate the costs of AFR.
