Ardal et al. / Pull incentives for antibiotics – TATFAR analysis of 6 models

Dear All:

​The TATFAR group has a new and very helpful paper out in Clinical Infectious Diseases in which they analyze 6 different kinds of pull incentives:

  1. Higher reimbursement
  2. Diagnosis confirmation (lower cost for a few days of empiric therapy, higher cost if diagnostics confirm ongoing need)
  3. A fully delinked market entry reward (no sales-based income)
  4. A market-priced market entry reward (some sales-based income)
  5. Tradable exclusivity vouchers, and
  6. An options market-based approach.

After reviewing pros/cons of each, the authors conclude: “It is critical that the implementation of any pull incentive is viewed in the overall context of the broader global strategy to combat AMR. The balance of promoting and rewarding innovation while ensuring patient access and aligning stewardship and public health objectives is necessary in the design of any successful pull incentive.  Strengthening surveillance systems to monitor the incentive are also integral. The incentive that appears able to capture those elements reasonably well while concurrently minimizing secondary disruptive effects is the market entry reward market-priced model.   While the delinked option would likely more effectively stimulate innovation directly benefiting unmet public health needs, we are concerned about the sustainability of the funding levels required.”

This conclusion is consistent with everything else I am seeing. The full analysis is worth reading!

See links below for the full paper … unfortunately, I can’t just post same for sharing as it does not appear to be Open Access.

All best wishes,


John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Chief Strategy Officer, CARB-X | Expert-in-Residence, Wellcome Trust
Follow me on Twitter: @JohnRex_NewAbx


Abstract: New alternative market models are needed to incentivize companies to invest in developing new antibacterial drugs.

In a previous publication (*), the Transatlantic Task Force on Antimicrobial Resistance (TATFAR) summarized the key areas of consensus for economic incentives for antibacterial drug development. That work determined that there was substantial agreement on the need for a mixture of push and pull incentives and particularly those that served to de-link the revenues from the volumes sold.

Pull incentives reward successful development by increasing or ensuring future revenue. Several pull incentives have been proposed that could substantially reward the development of new antibacterial drugs.

In this second paper authored by representatives of TATFAR, we examine the advantages and disadvantages of different pull incentives for antibacterial drug development. It is TATFAR’s hope that this analysis combined with other related analyses will provide actionable information that will shape policy makers thinking on this important issue.

* The prior publication is Sciarretta K, Rottingen JA, Opalska A, Van Hengel AJ, Larsen J. Economic Incentives for Antibacterial Drug Development: Literature Review and Considerations From the Transatlantic Task Force on Antimicrobial Resistance. Clinical Infectious Diseases. 2016;63(11):1470-4.



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