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

Introduction: 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. Areas covered: 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. Expert opinion: 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.