Antibiotic resistance (ABR) represents a serious and growing threat to human and animal health worldwide. In the EU alone, ABR is responsible for some 25 000 deaths every year, and the annual treatment and social costs have been estimated at some €1.5 billion. Meanwhile, new forms of resistance continue to arise and spread, leaving clinicians with few weapons to bring infections under control. Yet despite the recognised need for new antibiotics, the reality is that only two new classes of antibiotics have been brought to the market in the last three decades.
The reasons for this are manifold. On the scientific front, there is an urgent need for a greater understanding of how antibiotics work. In the regulatory arena, running clinical trials on new antibiotics is extremely challenging and costly. However, efforts to develop new antibiotics are also hampered by economics.
When bacteria are exposed to a new antibiotic, there is a risk that they will develop resistance. Therefore, new antibiotics should only be used when absolutely necessary, and ‘wise’ or ‘responsible’ use of antibiotics in both humans and animals represents a key aspect of wider efforts to tackle the spread of AMR. This means that sales of new antibiotics should be low, and as a result, the costs of development often exceed any potential return on investment. In other words, antibiotic development is simply no longer a financially viable option for large pharmaceutical companies, and only a few of such companies remain focused on this field.
Reconciling responsible use and economic incentives
DRIVE-AB’s goal is to design the building blocks of an innovative economic model that simultaneously incentivises the development of new antibiotics while ensuring they are used wisely.
One of the first tasks of the project is to deliver an evidence-based, consensus definition of ‘responsible antibiotic use’. They will also use data from surveillance systems, antibiotic prescription databases, and the scientific literature to estimate the current burden of ABR from clinical and economic standpoints. This information will feed into simulation models designed to estimate how ABR will impact on future public health needs in a range of socio-economic settings. These resources will enable the project team to devise valuation models capable of estimating the true value of new and existing antibiotics from the perspectives of patients, physicians, payers, and society as a whole.
The team will draw on all of these resources to generate alternative economic strategies and reward models that are in line with the project’s objective of promoting wise antibiotic use, incentivising antibiotic development, and ensuring access to all patients in need. The models will be tested extensively, and the most promising ones will be analysed, tested and explored in detail in collaboration with a multidisciplinary platform that brings together key stakeholders concerned about this issue.
At the end of the project, the strongest models and their implementation strategies will be presented at a stakeholder conference. The project is also committed to communicating its outcomes to governments and policymakers worldwide.
A strong team
The DRIVE-AB project brings together partners from academia and large pharmaceutical companies, with expertise in ABR, education and campaigning, health economics, health policy, political science, entrepreneurship, and pricing and market access. As such it is well placed to deliver solutions to the economic part of the puzzle of tackling ABR.