Selecting Efficient Farm-level Antimicrobial Stewardship Interventions from a one health perspective
It is often postulated that interventions to prevent the development and transmission of antimicrobial resistance (AMR) should be targeted at the livestock sector. The potential costs to agriculture are often argued as “worth it” for the long-term human (and animal) health benefits. However, a quantification of the relative benefits and costs for each system is lacking. Through shared learning across partners and secondary use of existing data, we plan on answering the question ‘What farm-level antimicrobial usage (AMU) interventions are most efficient at the national-level, given different scenarios of human health, AMU and AMR, for England, Denmark and Senegal?’, defining efficiency as the optimisation of resource use, given a set budget and a set of desired outcomes. We will use statistical, mathematical and economic modelling to construct a compartmental model that can assess (i) the interplay between animal, environment and human transmission of AMR, and (ii) the interplay between costs and benefits across One Health. We will analyse the impact of previously implemented intervention to inform modelling of future interventions under different AMR scenarios. Settings, costs and benefits will be specifically defined via expert elicitation through a stakeholder-led ‘knowledge hub’. This work will not only provide explicit impact estimates and ranking for a range of farm-level AMU interventions, it will also provide insight into uncertainty, highlighting where future research could be most valuable in understanding AMR intervention efficiency from a One Health perspective.
- Gwenan Knight, Liverpool School of Tropical Medicine, United Kingdom (Coordinator)
- Michel Dione, International Livestock Research Institute, Senegal (Partner)
- Ana Mateus, Royal Veterinary College, RVC, United Kingdom (Partner)
- Nichola Naylor, Public Health England, United Kingdom (Partner)
- Dagim Belay, University of Copenhagen, Denmark (Partner)
Antimicrobial resistance (AMR) links together people, plants, animals and their environments under the One Health umbrella. In this work we will similarly link interventions aimed at AMR by considering their impact not only in terms of impact on hospitals, communities or farmers, but across all of these groups. This is key to informing optimal intervention selection by governments in tackling AMR in the future. Our research will combine statistical analysis, mathematical simulations and economic-impact models within a single intervention assessment framework. We will bring together an interdisciplinary team of economists, mathematical modellers and veterinary scientists to apply this modelling framework to three country cases studies: the UK, Senegal and Denmark. All three countries are global leaders in terms of AMR data collection and intervention, providing ideal settings for intervention assessment. Our outcome will be an open sourced tool for policymakers to assess the One Health impact, and an insight into where more data in the future would be most beneficial, in terms of reducing uncertainty in such economic evaluations of interventions.