[Source: Science, full page: (LINK). Abstract, edited.]
The challenge of antimicrobial resistance: What economics can contribute
Laurence S. J. Roope1,2,3, Richard D. Smith4,*, Koen B. Pouwels5,6, James Buchanan1,2, Lucy Abel3,7, Peter Eibich8, Christopher C. Butler2,7, Pui San Tan7,9, A. Sarah Walker2,3,10, Julie V. Robotham2,5, Sarah Wordsworth1,2,3
1 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK. 2 The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK. 3 NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK. 4 University of Exeter Medical School, St Luke’s Campus, Exeter, UK. 5 Modelling and Economics Unit, National Infection Service, Public Health England, London, UK. 6 Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands. 7 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 8 Max Planck Institute for Demographic Research, Rostock, Germany. 9 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 10 Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.
*Corresponding author. Email: firstname.lastname@example.org
Science 05 Apr 2019: Vol. 364, Issue 6435, eaau4679 / DOI: 10.1126/science.aau4679
Incentivizing restraint in drug use
The accelerating tide of antimicrobial resistance (AMR) is a major worldwide policy concern. Like climate change, the incentives for individual decision-makers do not take into account the costs to society at large. AMR represents an impending “tragedy of the commons,” and there is an immediate need for collective action to prevent future harm. Roope et al. review the issues associated with AMR from an economics perspective and draw parallels with climate change. A major stumbling block for both challenges is to build consensus about the best way forward when faced with many uncertainties and inequities.
Science, this issue p. eaau4679
Antimicrobial resistance (AMR) is increasing, driven by widespread antibiotic use. The wide availability of effective antibiotics is under threat, jeopardizing modern health care. Forecasts of the economic costs are similar to those of a 2°C rise in global average surface temperature, above preindustrial levels. AMR is becoming an urgent priority for policy-makers, and pressure is mounting to secure international commitments to tackle the problem.
Estimating the value of interventions to reduce antibiotic use requires predictions of future levels of antibiotic resistance. However, modeling the trajectory of antibiotic resistance, and how marginal changes in antibiotic consumption contribute to resistance, is complex. The challenge of estimating the resulting impact on health and the economy is similarly daunting. As with the cost of climate change, estimates of total AMR costs are fraught with uncertainty and may be far too low. Much of the uncertainty arises from the complexity of estimating the cost of changes in overall resistance levels. This cost depends on various factors: which drug and pathogen are involved, the mechanism of antibiotic resistance, the prevalence of that pathogen, the types of infections it causes and their level of transmissibility, the health burden of those infections, and whether alternative treatments are available.
Effective new antibiotics are urgently needed. However, without government intervention, R&D for antibiotics is rarely profitable, and most major pharmaceutical companies have left the field. New ways are needed to make antibiotic development profitable, decoupling profits from volumes sold.
Analogies can be drawn between climate change and AMR, both of which have been described as a global “tragedy of the commons.” There is some consensus that we should treat carbon emissions reduction as an insurance policy against the possibility of a catastrophic climate outcome—and avoid waiting for a definitive optimum-abatement policy. A similar paradigm shift is needed to incentivize both the introduction and valuation of interventions to reduce antibiotic use and R&D of new antibiotics.
Rather than taxing the price and letting the market dictate the quantity of antibiotics supplied, an alternative may be to establish a regulatory body that issues prescribers tradable permits and to allow the market to determine the price. Such an approach could create a predictable revenue stream through more-foreseeable licensing fees for important antibiotics by decoupling the return on investment from the volume used. Approaches such as this could incentivize industry to develop new antibiotics for which there would otherwise be too small a market to provide a sufficient return on investment.
Reducing inappropriate antibiotic use while expanding essential access is a difficult challenge, especially in low- and middle-income countries. However, policy-makers and philanthropists are alert to the importance of AMR and increasingly are making substantial research funds available, with much of these funds devoted to the social sciences. We need economists, across many different fields, to engage with this pressing global problem.
As antibiotic consumption grows, bacteria are becoming increasingly resistant to treatment. Antibiotic resistance undermines much of modern health care, which relies on access to effective antibiotics to prevent and treat infections associated with routine medical procedures. The resulting challenges have much in common with those posed by climate change, which economists have responded to with research that has informed and shaped public policy. Drawing on economic concepts such as externalities and the principal–agent relationship, we suggest how economics can help to solve the challenges arising from increasing resistance to antibiotics. We discuss solutions to the key economic issues, from incentivizing the development of effective new antibiotics to improving antibiotic stewardship through financial mechanisms and regulation.
This is an article distributed under the terms of the Science Journals Default License.
Keywords: Antibotics; Drugs; Resistance; Global Health; Economics.