Economics perspectives on understanding antimicrobial use and resistance: a scoping review from theory to practice

Antimicrobial resistance (AMR) is a complex global health challenge with significant, yet underutilized economic dimensions. Beyond the clinical aspect, this growing threat demands interdisciplinary solutions that bridge economic theory and practice.

This scoping review synthesizes economic perspectives on AMR through systematic analysis from Ovid MEDLINE, Scopus, EconLit, and PubMed (December 2023 to June 2025). We examine four critical domains: (1) foundational economic theories explaining AMR drivers through public goods theory, tragedy of commons, externalities, and market failures; (2) real-world market dynamics including supply-demand imbalances and principal-agent relationships in clinical settings; (3) policy interventions spanning regulatory frameworks, fiscal measures, and behavioral economics applications in antimicrobial stewardship; and (4) economic evaluation methodologies encompassing descriptive, evaluative, and predictive analyses. Our analysis reveals how theoretical economic frameworks arise in healthcare practice and why comprehensive multi-component interventions outperform single-approach strategies.

Sustainable AMR mitigation requires fundamentally rethinking policy design through these interconnected economic lenses, transitioning from fragmented interventions to economically coherent frameworks that align short-term clinical decisions with long-term antimicrobial preservation. These changes demand unprecedented collaboration between economists, clinicians, and policymakers to align individual incentives with collective health security.