New economic models for antibiotics: Are we there yet? No, but we ARE on the road

Dear All,

The Duke-Margolis team hosted an excellent full-day workshop on 16 Jan 2020. Entitled “Exploring Opportunities to Reform Antimicrobial Payment and Post-Market Incentives” and chaired by Mark McClellan, the workshop’s outstanding cast of presenters and discussants provided a thorough discussion of both the need for new payment models and and the many ongoing activities focused on this challenge. There was a bit of an emphasis on activities in the US, but the ideas can certainly be applied globally. Materials from the day can be found here along with a link to the video replay of the day. 

You should try to listen to the discussion yourself but in the interval here are a few highlights:

  • The meeting’s briefing book (link) is an excellent survey of the economic problem of antibiotics. The document includes summaries of existing Push mechanisms/funders along with a survey of ongoing efforts to create Pull incentives. If you need an introduction to the area, this is a great place to start your studies.
  • Michael Craig (CDC) set the tone well for the day when he likened this discussion to the query “Are we there yet?” from the backseat of the car. No, we’re not there yet … but we are certainly on the road!
  • Monika Schneider (Duke-Margolis) gave us tour of the new Duke-Margolis concept for a Subscription Model (link). Building on the recent moves by CMS (link) to use the DRG system as a stepping stone (link), the Duke-Margolis team propose using Medicare’s authority to pilot new payment models through the Center for Medicare and Medicaid Innovation (CMMI). To quote from their paper, qualifying priority antibiotics would receive a subscription payment that “would be expected to cover the cost of an antibiotic supply that meets population health needs and the facilitation of post-market evidence monitoring. Because the priority antibiotics provide external societal benefits beyond their value to an individual treated payment, the subscription payment should exceed the volume-based price.” Lot of details to resolve, but the concept is certainly sound.
  • On the thorny topic of “What’s a new antibiotic worth?”, Nick Crabb (NICE, UK’s National Institute for Health and Care Excellence) gave us a high-level update on the UK’s progress towards a subscription model (go here for background on this). In brief, they are well launched on this project and we all eagerly await their views on ways to account for the full value of an antibiotic. If you’re not familiar with their approach, a great place to start is with the note cited just above but then read the superb report entitled “Framework for Value Assessment of New Antimicrobials” by Rothery et al (link).

My summary observation from the day is that the big nut to crack is the question of “What is that new antibiotic worth?” We have plausible tools for delivering rewards … now we need tools that help us decide what it is all worth. I cite above the work by the UK, but the discussion at the workshop on this topic was excellent so I’ll suggest that you should at least listen to the value discussion in the last 1h 15 minutes of the day by starting here in the YouTube replay (4h 46 minutes from start).

In particular, Kevin Outterson is starting a research project that will build an open, transparent cost/value model and seeks collaborators to join him. Kevin has kindly agreed to share his slides from the day (link). We await his final modeling, but the minimum global market entry reward that would encourage the private investment needed to deliver approved priority antibiotics seems likely to converge on $1b.

With thanks to the team at Duke-Margolis for organizing a great day (and with a shout-out to Wellcome Trust for supporting their work),

All best wishes, –jr

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Operating Partner, Advent Life Sciences. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future:

Upcoming meetings of interest to the AMR community:

  • 21 Jan 2020 (1700-1830 CET, online): GARDP-sponsored webinar entitled “Testing for the potential of emergence of resistance.” Go here to register.
  • 28-29 Jan 2020 (Rockville, MD, NIAID campus): Two-day workshop entitled “Understanding the Biology, Antifungal Resistance and Clinical Implications of Candida auris.” Draft agenda is here and registration is here.
  • [NEW] 12 Feb 2020 (Alderley Park, UK): “2020 Bioinfect Conference” sponsored by Bionow (link), the NW England life science accelerator. Go here to register.
  • 20 Feb 2020 (London, UK): Westminster Health Forum conference entitled “Antimicrobial resistance – coordinating a global response and progress on the UK strategy.” Go here for details.
  • 24 Feb 2020 (London, UK): One-day workshop hosted by Royal College of Nursing and the Longitude Prize entitled “Developing point-of-care diagnostics for urinary tract infections (UTIs): addressing clinical need in the UK.” Register here.
  • 26-27 Feb 2020 (Washington, DC): US PACCARB public meeting. Go here for details.
  • 27 Feb 2020 (1700-1830 CET, online): GARDP-sponsored webinar entitled “PK/PD murine infection models: Focus on study elements, variability, and interpretation of results.” Go here to register.
  • 1-6 Mar 2020 (Il Ciocco, Tuscany, Italy): Gordon Research Conference (GRC) on Antibacterial Discovery and Development: “Now is the time to re-boot antibiotic R&D before it’s too little, too late.” Go here for details.
  • 12-13 Mar 2020 (Basel): BEAM-, Novo REPAIR-, CARB-X-, DZIF-, ND4BB-, ENABLE-supported (among a long list!) Conference on Novel Antimicrobials and AMR Diagnostics. Details are here, poster deadline is 12 Dec 2019.  
  • 16-17 Mar 2020 (London): BSAC Spring Conference entitled: “Bridging the gap between science, policy and effective antimicrobial use.” Go here for details. 
  • 26-30 Mar 2020 (Atlanta, GA): CDC- and SHEA-sponsored 6th International Conference on Healthcare Associated Infections. Go here for details.
  • 30 Mar 2020 (everywhere): Deadline for applications for the Molecular Mycology pathogenesis course at Marine Biological Laboratory, Woods Hole. Now in its 24th year, the hands-on residential course runs 17 July to 2 Aug and gets rave reviews. Go here for more.
  • 9 Apr 2020 (everywhere): Final date for applications for NIAID/DMID call (link) for AMR-related vaccines, therapeutics, and diagnostics.
  • 18-21 Apr 2020 (Paris): Annual ECCMID meeting (#30)
  • 25-30 May 2020 (Rotterdam), Annual ESPID meeting (European Society for Pediatric ID, #38)
  • 18-22 Jun 2020 (Chicago), ASM Microbe 2020. Go here for details.
  • 27-28 Jun 2020 (Bryant University, Rhode Island): Drug Resistance Gordon Research Seminar entitled “Mechanisms and Approaches to Overcoming Drug Resistance in Cancer, Infectious Disease and Agriculture” for graduate students and postdoctoral scientists. Go here for details … this immediately precedes the GRC listed just next
  • 28 Jun-3 Jul 2020 (Bryant University, Rhode Island): Gordon Research Conference (GRC) entitled “Strategies to Disrupt Drug Resistance in Infectious Disease, Cancer and Agriculture.” Go here for details.
  • 1-4 Sep 2020 (Dublin): Annual ASM-ESCMID Conference on Antibiotic Development #5! Mark your calendar now and go here for details.
  • 9-10 Sep 2020 (Washington, DC): US PACCARB public meeting. Go here for details.
  • 22-25 Sep 2020 (Albuquerque, New Mexico): Biannual meeting of the MSGERC (Mycoses Study Group Education and Research Consortium). Save-the-date announcement is here, details to follow.
  • 17-25 Oct 2020 (Annecy, France): Interdisciplinary Course on Antibiotics and Resistance (ICARe). This is a soup-to-nuts residential course on antibiotics, antibiotic resistance, and antibiotic R&D. The course is very intense, very detailed, and gets rave reviews. The date is set for 2020 and the program will ultimately appear here. Registration is limited to 40 students and opens 15 Mar 2020.
  • 10-13 Apr 2021 (Vienna): Annual ECCMID meeting (#31)
  • 3-7 Jun 2021 (Anaheim), ASM Microbe 2021. Go here for details.


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