The health and economic impact of respiratory syncytial virus (rsv) prophylactics on antibiotic use and resistance in England
File(s)
Author(s)
Miller, Lucy
Type
Thesis
Abstract
Background: Respiratory Syncytial Virus (RSV) prophylactics, including vaccines and monoclonal antibodies, could reduce the burden of RSV infections. However, to be able to fully capture the benefit of RSV prophylactics, a better understanding of the potential impact of reduced RSV infection on the use of different types of antibiotics and subsequent antimicrobial resistance (AMR) selection and development is needed. With emerging RSV prophylactics, it is crucial to develop models evaluating their full economic and health impacts, including the impact on antibiotic use and resistance, to ensure immunisation and AMR policy decisions improve overall population health.
Aim: To evaluate the health and economic impact of RSV prophylactics on antibiotic use and resistance in England.
Methods: Population time series analysis utilised nationally representative primary care records and microbiology surveillance to predict RSV-attributable antibiotic prescriptions by age and class. These estimates informed probabilistic health economic models utilising a dynamic transmission model of RSV prophylactics to assess their impact on antibiotic use and resistance.
Results: An estimated 2.1% of primary care antibiotic prescriptions were attributable to RSV, with the largest volume among older adults and the majority from classes typically used for respiratory tract infections. Seasonal vaccination of adults ≥65 years was projected to reduce the most antibiotic prescriptions and reported resistant E. coli UTIs by 0.36% and 0.29%, respectively. However, the associated savings and health benefits of these reductions were minimal, constituting <0.1% of the total incremental costs and benefits of all programmes.
Conclusion: RSV prophylactics, particularly for older adults, may considerably reduce the burden of RSV infections and complement national antibiotic reduction strategies. However, the impact of strategies on resistant UTIs appears minimal. This thesis provides a basis for future models to assess the broader effects of antibiotic use, enhancing insights into RSV prophylactics' role in combating AMR.
Aim: To evaluate the health and economic impact of RSV prophylactics on antibiotic use and resistance in England.
Methods: Population time series analysis utilised nationally representative primary care records and microbiology surveillance to predict RSV-attributable antibiotic prescriptions by age and class. These estimates informed probabilistic health economic models utilising a dynamic transmission model of RSV prophylactics to assess their impact on antibiotic use and resistance.
Results: An estimated 2.1% of primary care antibiotic prescriptions were attributable to RSV, with the largest volume among older adults and the majority from classes typically used for respiratory tract infections. Seasonal vaccination of adults ≥65 years was projected to reduce the most antibiotic prescriptions and reported resistant E. coli UTIs by 0.36% and 0.29%, respectively. However, the associated savings and health benefits of these reductions were minimal, constituting <0.1% of the total incremental costs and benefits of all programmes.
Conclusion: RSV prophylactics, particularly for older adults, may considerably reduce the burden of RSV infections and complement national antibiotic reduction strategies. However, the impact of strategies on resistant UTIs appears minimal. This thesis provides a basis for future models to assess the broader effects of antibiotic use, enhancing insights into RSV prophylactics' role in combating AMR.
Version
Open Access
Date Issued
2023-12-20
Date Awarded
2024-06-01
Copyright Statement
Attribution-NonCommercial 4.0 International Licence (CC BY-NC)
License URL
Advisor
Costelloe, Cèire
Pouwels, Koen
Robotham, Julie
Sponsor
Medical Research Council (Great Britain)
Grant Number
MRF-145-0004-TPG-AVISO
Publisher Department
School of Public Health
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)