Existing Evidence from Economic Evaluations of Antimicrobial Resistance-A Systematic Literature Review

Background/Objectives: Although antimicrobial resistance (AMR) is recognized as a critical global health threat across human, animal, and environmental domains, evidence from AMR economic evaluations remains limited. This study systematically reviewed available studies, emphasizing existing evidence and reported limitations in AMR-related economic evaluations. Methods: A comprehensive review of peer-reviewed empirical studies was conducted, including publications up to July 2023 without temporal restrictions, but limited to English-language articles. Literature searches were undertaken in PubMed and Cochrane using a search strategy centered on the terms "economic evaluations" and "antimicrobial resistance." Screening and data extraction were performed by two reviewers independently, with disagreements resolved through consensus or consultation with a third reviewer. Findings were synthesized narratively. Results: Of the 3682 records screened, 93 studies were included. Evidence gaps were identified across income and geographic regions, particularly in low- and middle-income countries (LMICs) and the African, Southeast Asian, and Eastern Mediterranean regions. Studies were comparatively more numerous in high-income countries (HICs) and the European and Americas regions. Substantial gaps also existed in one health approach and community-based evaluations. Nine major study limitations were identified, with many interlinked. The most frequent issues included limited generalizability primarily due to inadequate sampling approaches (n = 16), and single-center studies (n = 11), alongside errors in cost estimation (n = 4), and lack of consideration for essential features or information (n = 3). Conclusions: The review highlights persistent evidence gaps and recurring methodological shortcomings in AMR economic evaluations. Addressing these limitations, particularly in LMICs, will strengthen the evidence base and better inform policy implementation to combat AMR effectively.