Incentives for antibiotics: Recent papers, with an emphasis on Pull

Dear All: 

For your weekend reading list, I have some papers on the topic of (mostly pull) incentives for antibiotics.

First, I previously wrote about the survey from TATFAR (Transatlantic Task Force on Antimicrobial Resistance) of 6 possible pull models (higher reimbursement, diagnostic confirmation, market entry rewards both fully and partially delinked, tradable exclusivity vouchers, and an options market). The final paper is now out (Ardal et al., Clin Infect Dis, 15 Oct 2017) and is definitely worth reading. You’ll also want to (re)review their prior paper (Sciaretta et al., Clin Infect Dis, 2016) on push and pull incentives.

The short summary of these papers would be that (a) we need both Push and Pull incentives and (b) there is no perfect Pull incentive but the one that seems to provide the best balance of useful effects with minimal disruption is the idea of a market entry reward that uses relatively smaller rewards to top up market-based revenues. This is also sometimes called a partially delinked market entry reward model.

Consistent with this,a new paper from Towse et al. has recently appeared in Health Policy (disclaimer — I am a co-author on this paper). Entitled “Time for a change in how new antibiotics are reimbursed: Development of an insurance framework for funding new antibiotics based on a policy of risk mitigation”, this paper compares a higher (premium) price Pull model with a partially delinked model. It concludes that:

  • A premium price model has uncertain impact and risks putting commercial return and appropriate stewardship in opposition.
  • An insurance model can achieve investment, reduce uncertainty for health systems, and achieve stewardship.

Third, don’t forget that DRIVE-AB is continuing to generate materials. Their July 2017 commentary to the G20 is consistent with all of the above and their final reports should start to appear soon.

Finally, IDSA’s Stakeholder Forum on Antimicrobial Resistance (http://s-far.org/; link no longer working as of March 2022) is a partnership of  more than 100 health organizations seeking to ensure that any U.S. government strategy to address antimicrobial resistance involves sustained and meaningful engagement with non-government experts and stakeholders throughout the policy development and implementation process. Their website provides links to a variety of key documents on AMR.

All best wishes, –jr

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Expert-in-Residence, Wellcome Trust. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: http://amr.solutions/blog/

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