What would happen to the healthcare system without antibiotics?
The responsible use of antibiotics requires minimizing their usage, which discourages pharmaceutical investment and innovation. But without access to effective antibiotics, healthcare systems could not function as they do today.
Impact on medical procedures
Necessary medical procedures could become too dangerous to perform, with 50.9% of surgical site infections already caused by resistant pathogens.
Increased hospitalization
An estimated 569 million extra days of AMR-related hospitalization annually in Europe by 2050 will increase burden on the healthcare system and impact available care for other patients.1
Commercial implications
Infection, or risk of infection, could pose a significant threat to revenue by delaying or preventing the use of other high-value portfolio therapies, e.g. in oncology and other therapy areas associated with immuno-suppression.
Why should we view antibiotics as essential infrastructure to healthcare delivery?
Our current view of antibiotics as rescue medications, paid for only when needed, is flawed. Instead, we need to see them as crucial infrastructure, always available to support the delivery of healthcare.
Actions to support antibiotics as infrastructure
- Invest in the development and production of antibiotics
- Maintain availability by ensuring the supply chain is robust and ready
- Ensure patient access when needed to support delivery of effective healthcare
Antibiotics as fire extinguishers
A useful analogy is to think of antibiotics as fire extinguishers; we invest in the acquisition and maintenance of fire extinguishers, while hoping that the actual number of fires is zero
How can funding structures enable antibiotics to function as infrastructure?
Infrastructure is supported by reliable, consistent, and sustainable funding. To implement antibiotics as infrastructure we must rethink how we fund their development and reimbursement through:
- Incentivizing companies to invest in new antibiotics without jeopardizing efforts to maintain proper antimicrobial stewardship
- De-coupling volume from revenue and reimbursing based on value to society
Some countries have established/proposed reforms to facilitate the implementation of antibiotics as infrastructure, including:
NICE introduced a “subscription model,” decoupling price from volume and capturing broader value with specific scoring criteria for antimicrobials, which is translated into an annual subscription cost
The PASTEUR act has been proposed in the US, under which antimicrobial revenue would be decoupled from volume of use, with contracts of $7mn-$3bn awarded for the provision of access to novel antimicrobials rather than quantity of sales
Other pricing and reimbursement reforms such as the “proper use cooperation fee” proposed in Japan can also delink revenue from volume and help to provide a sustainable source of funding for antibiotics
CRA’s in-house anti-infectives experts are available to guide your asset through the changing anti-infectives landscape, with expertise across Pricing & Market Access, Commercial Strategy & Business Development and Policy.
1 OECD (2019). Antimicrobial Resistance: Tackling the Burden in the European Union.
