Discrete choice experiment to investigate preferences for incentives to promote antimicrobial research and development.

OBJECTIVES: Without intervention, experts predict that antimicrobial resistance will rank among leading drivers of mortality by 2050. New drugs are desperately needed, but given the lengthy development timelines for antimicrobial research and development (R&D), existing economic incentives fail to support a robust pipeline of new products. This study aims to elicit the preferences of stakeholders for adequate antimicrobial R&D incentive programs. METHODS: A discrete choice experiment was conducted in which stakeholders (representatives from small or medium and large pharmaceutical companies, academics, clinicians, and policy makers) were asked in 12 choice tasks to select their preferred incentive combinations among two hypothetical options, differing in five attributes: form of monetary incentive, total amount of monetary incentive, market exclusivity extensions, transferable exclusivity extensions vouchers, and priority review vouchers. A subgroup analysis comprising only participants from the pharmaceutical industry was also conducted. RESULTS: A total of 50 stakeholders (including 24 from the pharmaceutical industry) completed the survey in full. Participants preferred longer transferable exclusivity extensions and larger amounts of monetary rewards. The levels that were perceived as having the highest utility were $1 billion as total amount of incentives and transferable exclusivity extension for 18 months. The subgroup analysis provided similar findings. CONCLUSION: This study suggests that survey participants viewed transferable exclusivity vouchers for an 18-mo term and higher ($1 billion) monetary rewards as the preferred incentives to promote antimicrobial R&D. Further work is needed to design specific incentives and ensure they are implemented effectively.

The Role of Pharmaceutical Companies in Antimicrobial Stewardship: A Case Study.

Rising levels of antimicrobial resistance pose serious dangers to patients, population health, food security, and economic stability worldwide. In response to this threat, the United Nations and the World Health Organization have called for multisectoral, multidisciplinary action, recognizing that human, animal, and environmental health are interdependent. Although the pharmaceutical industry clearly has a leading role in developing novel antimicrobials and vaccines, it is also active in many areas supporting antimicrobial stewardship. This article describes why pharmaceutical companies invest in antimicrobial stewardship, outlines why they are well suited to help address this issue, and provides examples of how the pharmaceutical industry can support the responsible use of antimicrobials. Merck & Co., Inc. (Kenilworth, NJ, USA), a large, globally operating pharmaceutical company that develops and markets both human and veterinary antimicrobials and vaccines is used as a case study for illustrating industry involvement in antimicrobial stewardship efforts.

A Perspective on Incentives for Novel Inpatient Antibiotics: No One-Size-Fits-All.

The need for new "pull" incentives to stimulate antibiotic R&D is widely recognized. Due to the global diversity of health systems, combined with different challenges faced by antibiotics used in different types of healthcare settings, there is no one-size-fits-all solution. Instead, different "pull" incentives should be tailored to local contexts, priorities, and antibiotic types. Policymakers and industry should collaborate to identify appropriate solutions at the local, regional, and global levels.

Diagnosis Confirmation Model: A Value-Based Pricing Model for Inpatient Novel Antibiotics.

The Diagnosis Confirmation Model (DCM) includes a dual-pricing mechanism designed to support value-based pricing of novel antibiotics while improving the alignment of financial incentives with their optimal use in patients at high risk of drug-resistant infections. DCM is a market-based model and complementary to delinked models. Policymakers interested in stimulating antibiotic innovation could consider tailoring the DCM to their reimbursement systems and incorporating it into the suite of incentives to improve the economics of antibiotics.