# Understanding the Financial Implications of Antimicrobial Resistance Surveillance in Nepal: Context-Specific Evidence for Policy and Sustainable Financing Strategies

## TL;DR

This study estimates the 10-year cost of AMR surveillance in Nepal across human, animal, and food sectors to guide sustainable financing strategies.

## Contribution

The first multi-sectoral cost analysis of AMR surveillance in Nepal, providing evidence for long-term national financing.

## Key findings

- Total AMR surveillance cost in Nepal from 2021–2030 is estimated at $6.7 million.
- Laboratories account for over 90% of costs, with consumables and personnel as main drivers.
- Human health surveillance is the most expensive sector, followed by animal and food.

## Abstract

Background/Objectives: Antimicrobial resistance (AMR) surveillance is a cornerstone of national AMR strategies but requires sustained, cross-sectoral financing. While the need for such financing is well recognized, its quantification remains scarce in low- and middle-income countries. This study aimed to estimate the full costs of AMR surveillance across the human health, animal health, and food sectors (2021–2030) in selected facilities in Nepal and generate evidence to inform sustainable financing. Methods: A bottom-up micro-costing approach was used to analyze data from five sites. Costs were adjusted for inflation using projected gross domestic product deflators, and probabilistic sensitivity analyses were conducted to assess uncertainty in laboratory sample volumes under four scenarios. Results: The total cost of AMR surveillance in Nepal was $6.7 million: $3.4 million for human health (50.3% out of the aggregated costs), $2.7 million for animal health (39.8%), and $0.7 million for the food sector (9.9%). Laboratories accounted for >90% of total costs, with consumables and personnel as the main cost drivers. Average cost per sample was $150 (animal), $64 (food), and $6 (human). Conclusions: This study offers the first robust, multi-sectoral 10-year cost estimates of AMR surveillance in Nepal. The findings highlight that sustaining AMR surveillance requires predictable domestic financing, particularly to cover recurrent laboratory operations as donor support declines. These results provide cost evidence to support future budgeting and policy planning toward sustainable, nationally financed AMR surveillance in Nepal.