Estimating Economic Costs Associated with Treating Antimicrobial-Resistant Infections in Humans in Malawi

Background: Antimicrobial resistance (AMR) poses a significant threat to global health and economic development. In Malawi, the economic costs associated with the treatment of AMR infections remain largely unknown which may hinder resource allocation and policy prioritization. Method: The study used a cross-sectional design and was conducted between September 2023 and January 2025 at three different hospital settings. Data were collected from inpatients with laboratory-confirmed urinary tract infection (UTI) or blood stream infection (BSI). Additional follow-up data were collected from patients for four weeks post discharge. We analyzed patient level data first using descriptive statistics and employed an instrumental variable 2-stage least squares regression to estimate drivers of AMR treatments costs. Results: A total of 610 patients participated in the study. Of these, 45% had AMR-associated resistant infections. Overall, E. coli (43%) followed by P. aeruginosa (22%), K. pneumoniae (14%), and S. aureus (10%) were the most common pathogens. UTI was marginally more common (51%) compared to BSI (49%). BSI had a higher average cost than UTI for patients with both susceptible and resistant infections. On average, a patient spent MK283,815.10 (US$163.71) ranging from zero to MK13,500,000 (US$7786.90). Patients with resistant infections incurred, on average, MK161,785 (US$93.32) more than patients with susceptible infections, largely driven by prolonged hospitalization among other factors. Overall, the direct medical observed costs averaged MK37,165.29 (US$21.44) while direct non-medical observed costs averaged MK61,908.71 (US$35.71). Productivity losses for the patient and guardian(s) were a major observed cost averaging MK160,322.80 (US$92.49). The regression results further showed that having a bank account as a proxy of wealth, non-farm business, longer travel duration, BSI, and K. pneumoniae as the causative pathogens were significantly associated with increased cost burden among the patients. Conclusions: AMR-associated infections impose substantial economic burden on patients and households. Further strengthening of AMR surveillance and stewardship are needed as critical elements of Malawi’s National Action Plan. However, measures should also be taken to mitigate the economic consequences related to AMR, especially for patients who bear the brunt of these costs for lack of financial protection in Malawi’s health system.