{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T03:03:17Z","timestamp":1785380597467,"version":"3.55.0"},"reference-count":34,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Graduate School of Health at Aarhus University","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,14]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"\n Objective<\/jats:title>\n We performed a microsimulation analysis predicting the societal cost of antimicrobial resistance (AMR), which represents the potential cost savings if Ghana eliminates AMR.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n \n This study combined bacterial resistance epidemiology and cost data from Ghana to perform a microsimulation analysis focusing on sociodemographic groups, predicting the potential societal cost savings should Ghana eliminate AMR. The nationally representative data were collected from 12 reference laboratories across Ghana\u2019s three geographical belts between June 2021 and December 2023. Case definition was enterobacterial third-generation cephalosporin (3GC) resistant infections, methicillin-resistant\n Staphylococcus aureus<\/jats:italic>\n (MRSA) and multidrug-resistant\n Mycobacterium tuberculosis<\/jats:italic>\n . Using an adapted microsimulation framework, the simulation incorporated four integrated data modules: population demographics, infection epidemiology, healthcare resource use and expenditure and labour market characteristics. This approach allowed for the construction of synthetic individuals from national data sets and the projection of annual outcomes over a 7-year horizon. Costs were calculated from a societal perspective under a status quo scenario, assuming that admission rates, resistant infection probabilities and mortality rates remain the same. This analysis also considers a 2.1% annual population growth rate, a 5% discount rate for future costs and age-specific resistance risk profile. We stratified the outcome of interest by age groups, sex and wealth quintiles to account for distributional effects and reported the costs in purchasing power parity equivalent in international US dollars.\n <\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Ghana in West Africa.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n A simulated population of AMR patients of all ages and sex.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Societal cost attributable to AMR in Ghana.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Assuming probabilities of all-cause hospital admissions of 0.102 for females and 0.093 for males, along with probabilities of AMR infections of 0.239 and 0.193, we predicted nearly 78\u2009000 (95% CI 72\u2009000 to 83 520) annual AMR infections and approximately 6300 (95% CI 3900 to 8638) attributable deaths. MRSA and 3GC-resistant infections made up 20.2% and 79.2% of the predicted annual infections, corresponding to an estimated mean societal cost of about US$435\u2009million. In decreasing order of magnitude, the estimated mean annual cost of productivity loss due to AMR attributable mortality accounted for 40.6% of the mean annual societal cost, followed by the cost to healthcare providers (24.1%), direct medical cost to patients and caregivers (22.4%), productivity loss for surviving patients and caregivers (10.4%) and direct non-medical costs to patients and caregivers (2.6%). Resistant infections in children under 5 and adults over 60 years contributed 48.2% and 26.9% of the estimated annual societal cost, respectively. Except for the number of resistant infections, the estimated mean annual costs between wealth quintile groups were significantly different (p=0.03) due to differences in productivity costs between wealth quintile groups.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The study shows that the societal cost implications attributable to AMR are enormous, requiring a concerted effort by society to mitigate the development and spread of AMR organisms.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111045","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T15:41:40Z","timestamp":1770219700000},"page":"e111045","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Attributable societal cost of antimicrobial resistance in Ghana: a microsimulation study focusing on sociodemographic groups"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9367-1265","authenticated-orcid":false,"given":"Ama Pokuaa","family":"Fenny","sequence":"first","affiliation":[{"name":"Institute of Statistical, Social and Economic Research, University of Ghana, Legon, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6809-5160","authenticated-orcid":false,"given":"Evans","family":"Otieku","sequence":"additional","affiliation":[{"name":"Institute of Statistical, Social and Economic Research, University of Ghana, Accra, Ghana"},{"name":"Department of Public Health, Ghana Christian University College, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert Ofori","family":"Amoah","sequence":"additional","affiliation":[{"name":"Department of Public Health, Ghana Christian University College, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Jejeti","sequence":"additional","affiliation":[{"name":"Department of Health Policy Planning and Management, University of Ghana, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Appiah-Korang","family":"Labi","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Korle Bu Teaching Hospital, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George Kwesi","family":"Hedidor","sequence":"additional","affiliation":[{"name":"World Health Organization Regional Office for Africa, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrika","family":"Enemark","sequence":"additional","affiliation":[{"name":"Department of Public Health, Aarhus Universitet, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"2026062610403897000_16.2.e111045.1","doi-asserted-by":"crossref","DOI":"10.1126\/science.aau4679","article-title":"The challenge of antimicrobial resistance: What economics can contribute","volume":"364","author":"Roope","year":"2019","journal-title":"Science"},{"key":"2026062610403897000_16.2.e111045.2","doi-asserted-by":"crossref","DOI":"10.1186\/s13756-020-00822-6","article-title":"A one health framework to estimate the cost of antimicrobial resistance","volume":"9","author":"Morel","year":"2020","journal-title":"Antimicrob Resist Infect Control"},{"key":"2026062610403897000_16.2.e111045.3","doi-asserted-by":"publisher","DOI":"10.1086\/502018"},{"key":"2026062610403897000_16.2.e111045.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001104","article-title":"Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe","volume":"8","author":"de Kraker","year":"2011","journal-title":"PLoS Med"},{"key":"2026062610403897000_16.2.e111045.5","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)02724-0"},{"key":"2026062610403897000_16.2.e111045.6","unstructured":"Jonas OB , Irwin A , Berthe FCJ , et al . Drug-resistant infections: a threat to our economic future. In: final report (English). HNP\/Agriculture Global Antimicrobial Resistance Initiative. 2. Washington, D.C: World Bank Group, 2017. Available: http:\/\/documents.worldbank.org\/curated\/en\/323311493396993758\/final-report"},{"key":"2026062610403897000_16.2.e111045.7","unstructured":"AMR Quadripartite . Road map for updating the global action plan on AMR Quadripartite Joint Secretariat, 2025. Available: https:\/\/www.qjsamr.org\/docs\/librariesprovider25\/default-document-library\/gapamr-roadmap.pdf?sfvrsn=a189ffff_8"},{"key":"2026062610403897000_16.2.e111045.8","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics12111613","article-title":"Education and Awareness on Antimicrobial Resistance in the WHO African Region: A Systematic Review","volume":"12","author":"Fuller","year":"2023","journal-title":"Antibiotics (Basel)"},{"key":"2026062610403897000_16.2.e111045.9","unstructured":"Kodua A . End-term assessment of amr policy and nap (2017-2021) report. Accra, Ghana, 2023."},{"key":"2026062610403897000_16.2.e111045.10","doi-asserted-by":"crossref","DOI":"10.1186\/s42522-021-00051-w","article-title":"Antimicrobial resistance national level dialogue and action in Ghana: setting and sustaining the agenda and outcomes","volume":"3","author":"Koduah","year":"2021","journal-title":"One Health Outlook"},{"key":"2026062610403897000_16.2.e111045.11","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s41669-022-00385-9","article-title":"Attributable Patient Cost of Antimicrobial Resistance: A Prospective Parallel Cohort Study in Two Public Teaching Hospitals in Ghana","volume":"7","author":"Otieku","year":"2023","journal-title":"Pharmacoecon Open"},{"key":"2026062610403897000_16.2.e111045.12","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1093\/heapol\/czad114","article-title":"Healthcare provider cost of antimicrobial resistance in two teaching hospitals in Ghana","volume":"39","author":"Otieku","year":"2024","journal-title":"Health Policy Plan"},{"key":"2026062610403897000_16.2.e111045.13","unstructured":"Global Leaders Group (GLG) on AMR . Towards specific commitments and action in the response to antimicrobial resistance, 2024. Available: https:\/\/www.amrleaders.org\/resources"},{"key":"2026062610403897000_16.2.e111045.14","unstructured":"World Bank Group . Population growth (annual %) \u2013 Ghana. 2024. Available: https:\/\/data.worldbank.org\/indicator\/SP.POP.GROW?locations=GH"},{"key":"2026062610403897000_16.2.e111045.15","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics12020255","article-title":"Multicenter Surveillance of Antimicrobial Resistance among Gram-Negative Bacteria Isolated from Bloodstream Infections in Ghana","volume":"12","author":"Donkor","year":"2023","journal-title":"Antibiotics (Basel)"},{"key":"2026062610403897000_16.2.e111045.16","unstructured":"Organization for Economic Co-operation and Development (OECD) . Embracing a one health framework to fight antimicrobial resistance, 2023. Available: https:\/\/www.oecd.org\/en\/publications\/embracing-a-one-health-framework-to-fight-antimicrobial-resistance_ce44c755-en.html"},{"key":"2026062610403897000_16.2.e111045.17","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1093\/eurpub\/cky209","article-title":"A microsimulation model projecting the health care costs for resistance to antibacterial drugs in Sweden","volume":"29","author":"Larsson","year":"2019","journal-title":"Eur J Public Health"},{"key":"2026062610403897000_16.2.e111045.18","unstructured":"Ghana AMR Surveillance Team . Global antimicrobial surveillance system survey in Ghana. Accra, Ghana, 2024."},{"key":"2026062610403897000_16.2.e111045.19","unstructured":"WHO . WHO bacterial priority pathogens list, 2024: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance, 2024. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240093461"},{"key":"2026062610403897000_16.2.e111045.20","unstructured":"Institute of Health Metrics and Evaluation (IHME) . The burden of antimicrobial resistance (AMR) in Ghana AMR represents a global challenge, 2023. Available: https:\/\/www.healthdata.org\/sites\/default\/files\/2023-09\/Ghana.pdf"},{"key":"2026062610403897000_16.2.e111045.21","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X18754513"},{"key":"2026062610403897000_16.2.e111045.22","doi-asserted-by":"crossref","DOI":"10.1017\/S0266462323000193","article-title":"A consensus-based checklist for the critical appraisal of cost-of-illness (COI) studies","volume":"39","author":"Schnitzler","year":"2023","journal-title":"Int J Technol Assess Health Care"},{"key":"2026062610403897000_16.2.e111045.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-028224","article-title":"Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia","volume":"9","author":"Haenssgen","year":"2019","journal-title":"BMJ Open"},{"key":"2026062610403897000_16.2.e111045.24","unstructured":"Otieku E , Hedidor G , Lerouge A , et al . WHO Ghana Country Office Accra, Ghana; Investment case for tackling antimicrobial resistance in Ghana, 2025. Available: https:\/\/1drv.ms\/b\/c\/2e088c79e0533beb\/EdbdqR_IHh1Pi3jgBw90lKoBpg3ba_WDzdNGLJNgj_Vyhw?e=9udPOk"},{"key":"2026062610403897000_16.2.e111045.25","unstructured":"Government of Ghana . Policy on Antimicrobial Use and Resistance. 1st edn. Ministry of Health, Ghana, Accra, 2017."},{"key":"2026062610403897000_16.2.e111045.26","unstructured":"Government of Ghana . National Action Plan for Antimicrobial Resistance in Ghana. Ghana, Accra: Ministry of Health, 2017."},{"key":"2026062610403897000_16.2.e111045.27","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2014.20.4.327"},{"key":"2026062610403897000_16.2.e111045.28","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S88725"},{"key":"2026062610403897000_16.2.e111045.29","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1054\/tube.2002.0328","article-title":"Is Mycobacterium tuberculosis a closer relative to Gram-positive or Gram-negative bacterial pathogens?","volume":"82","author":"Fu","year":"2002","journal-title":"Tuberculosis (Edinb)"},{"key":"2026062610403897000_16.2.e111045.30","unstructured":"Ghana Health Service . Ghana harmonized health facility assessment report. Ghana Health Service, Accra, Ghana, 2023."},{"key":"2026062610403897000_16.2.e111045.31","unstructured":"Ghana Statistical Service . Third quarter labour statistics report, 2023. Available: https:\/\/statsghana.gov.gh\/searchread.php?searchfound=NzkyMjcwNDM5NzAuMjUz\/search\/pn13pn3q80"},{"key":"2026062610403897000_16.2.e111045.32","unstructured":"UNDP . Ghana\u2019s economic development update. salary increments and economic realities. 2023. Available: https:\/\/www.undp.org\/sites\/g\/files\/zskgke326\/files\/2023-05\/UNDP%20Ghana_Policy%20Brief_on%20Economic%20Updates_%201_Salary_Increases_2.pdf"},{"key":"2026062610403897000_16.2.e111045.33","unstructured":"Ghana 2022 earnings inequality in the Public Sector, Available: https:\/\/statsghana.gov.gh\/gssmain\/fileUpload\/pressrelease\/Earnings%20Inequality%20Report%2014-02-2023.pdf"},{"key":"2026062610403897000_16.2.e111045.34","unstructured":"Opoku K , Boahen EA , Domfe G . Understanding the gender wage gap in the formal and informal sectors of the Ghanaian economy. Niger J Econ Soc Stud 2024;66."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-111045","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:41:52Z","timestamp":1782495712000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-111045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,4]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2025-111045"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-111045","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}