# 5. Cost of drugs, supplies and laboratory tests

In addition to the cost of a bed day is the cost of medications, supplies, and laboratory tests to properly treat an infection.

The estimation of the drug costs of HAI in this study is complicated by the fact that information is missing or complicated to collect on (a) what infections account for the majority of infections in each country; (b) the age profile of patients (infants, children, adults); (c) the dosage and form of medication given; and (d) what is the unit cost of each of the first line drugs. In addition, the laboratory costs will depend on what laboratory tests are available at each level of care, the national standard procedures and the extent to which these are followed by medical staff. Hence, it is necessary to extrapolate these costs from the best available evidence from available study (-ies) that represent other countries.

None of the studies presented in the introduction section on the costs of inaction on AMR provided medical costs. Salman et al (2020) conduct a systematic review on the impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults, with most studies from USA and only one study from Africa (Algeria). Hence, it is necessary to draw on the published literature and online data sources. However, very few studies are available from Africa on the costs of treating HAIs and AMR.

Given the present study estimated the costs of treating HAIs at different levels of care, African studies were sources and matched to each level of care (see Table 8).

Aerts et al (2022) estimated the costs of neonatal admission for acute bacterial sepsis in a district hospital in Mozambique. The total medication costs are I$47.9 or US$17.7 and total laboratory costs are I$114 or US$42.2. In case of the latter, the majority are lumbar puncture and CSF test. If only blood culture, urine culture, full blood count test and blood glucose test are included, it is lower at I$34.5 or US$12.75. Hence the drug costs (US$17.7) and laboratory costs (US$12.75) were extrapolated to all other 8 countries at PPPs to represent the health center level.

Gidey et al (2023) compare the cost of treating HAI versus non-HAI patients in Ethiopia, and find an additional US$6.03 for procedures and investigations, US$4.72 more for hospital bed and US$47.2 more for drugs. Hence, the non-bed cost adds up to US$53.2 extra. These costs were extrapolated to the other 8 countries at PPPs to represent the district hospital level.

Boucoum et al (2019) estimate the costs of treating surgical site infections in a teaching hospital in Mali at FCFA 119,837 in 2016, which was updated to 2022 prices and converted to costs in the 9 study countries using PPP conversion.

One study compared the median prices of selected antibiotics in DRC and Cameroon with the international reference price (Schäferman et al, 2020), and found that, on average, the drugs were 2.2 and 5.7 times more expensive in these countries, respectively. For DRC, for the drugs mentioned above in the HAI rate section, it varied from 1.7 times for Ciprofloxacin to 4.6 times for Amoxicillin/Clavulanic. To pay for the latter, a patient would need to work 10 days of wages at the minimum wage.

In Ghana, Otieku et al (2023) found that having an HAI (non-AMR) increased drug cost by 9% and increased laboratory cost by 85%. However, no monetary cost figures are provided.

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