Optimal subscription models to pay for antibiotics

Barlow, Euan; Morton, Alec; Colson, Itamar Megiddo Abigail

doi:10.1016/j.socscimed.2022.114818

Cited by 5 publications

(8 citation statements)

References 26 publications

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“…Gonorrhoea AMR assumptions : Variable but inconsistent assumptions about resistance were made, including the prevalence of gonorrhoea AMR (in 9/13 studies [ 11 , 32 – 34 , 36 – 38 , 40 , 42 ]), what therapy would be used when AMR was present (in 4/12 studies [ 12 , 32 , 34 , 37 ]), and the degree of clinical effectiveness for modelled antibiotics (in 2/12 studies [ 35 , 39 ]).…”

Section: Resultsmentioning

confidence: 99%

“…The most frequent perspective adopted was that of the healthcare provider, but this may underestimate the total cost of resistance [ 16 ] by not including the full cost of morbidity, loss of income, reduced productivity and use of antibiotic prophylaxis. A more consistent and comprehensive approach to incorporate patient and societal costs of AMR is therefore desirable [ 14 , 16 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

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Economic evaluation of antimicrobial resistance in curable sexually transmitted infections; a systematic review and a case study

Ayinde,

Ross,

Jackson

2023

PLoS ONE

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Objective To provide a summary of the economic and methodological evidence on capturing antimicrobial resistance (AMR) associated costs for curable sexually transmitted infections (STIs). To explore approaches for incorporating the cost of AMR within an economic model evaluating different treatment strategies for gonorrhoea, as a case study. Methods A systematic review protocol was registered on PROSPERO (CRD42022298232). MEDLINE, EMBASE, CINAHL, Cochrane Library, International Health Technology Assessment Database, National Health Service Economic Evaluation Database, and EconLit databases were searched up to August 2022. Included studies were analysed, quality assessed and findings synthesised narratively. Additionally, an economic evaluation which incorporated AMR was undertaken using a decision tree model and primary data from a randomised clinical trial comparing gentamicin therapy with standard treatment (ceftriaxone). AMR was incorporated into the evaluation using three approaches—integrating the additional costs of treating resistant infections, conducting a threshold analysis, and accounting for the societal cost of resistance for the antibiotic consumed. Results Twelve studies were included in the systematic review with the majority focussed on AMR in gonorrhoea. The cost of ceftriaxone resistant gonorrhoea and the cost of ceftriaxone sparing strategies were significant and related to the direct medical costs from persistent gonorrhoea infections, sequelae of untreated infections, gonorrhoea attributable-HIV transmission and AMR testing. However, AMR definition, the collection and incorporation of AMR associated costs, and the perspectives adopted were inconsistent or limited. Using the review findings, different approaches were explored for incorporating AMR into an economic evaluation comparing gentamicin to ceftriaxone for gonorrhoea treatment. Although the initial analysis showed that ceftriaxone was the cheaper treatment, gentamicin became cost-neutral if the clinical efficacy of ceftriaxone reduced from 98% to 92%. By incorporating societal costs of antibiotic use, gentamicin became cost-neutral if the cost of ceftriaxone treatment increased from £4.60 to £8.44 per patient. Conclusions Inclusion of AMR into economic evaluations may substantially influence estimates of cost-effectiveness and affect subsequent treatment recommendations for gonorrhoea and other STIs. However, robust data on the cost of AMR and a standardised approach for conducting economic evaluations for STI treatment which incorporate AMR are lacking, and requires further developmental research.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Economic evaluation of antimicrobial resistance in curable sexually transmitted infections; a systematic review and a case study

Ayinde,

Ross,

Jackson

2023

PLoS ONE

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“…There have been many initiatives to increase research and development in the pharmaceutical industry for other urgent public health needs. Some authors have proposed government economic incentives to advance research and development into antibiotics for multi-resistant bacteria [ 45 , 46 ], cancer drugs [ 47 , 48 ], medicines [ 49 ], and malaria vaccines [ 50 ]. These incentives may include research grants, rewards for research advancements, and facilitating access to knowledge through open-source platforms [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

How Did We Get Here: The Best Vaccines Ever Facing the Highest Public Hesitancy?

Ferreccio

2023

Vaccines

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mRNA vaccine technology is the most interesting final product of decades of research. This new platform for public health is simple to transfer to low-income countries and can be used against diverse agents, including cancer. It is environmentally clean, relatively low-cost, and does not use animals for its production. Most importantly, mRNA vaccines have been highly efficacious in avoiding serious disease and death from COVID-19. Yet, at the highest point of the pandemic, many voices, including some from prominent positions, opposed their use. Similarly, the Human Papillomavirus (HPV) vaccines, which are highly effective, very safe, and probably confer long life protection against its HPV types, faced strong parents’ hesitancy. Vaccine hesitancy has been the subject of extensive research, focusing primarily on factors associated with the public, the political environment, and messaging strategies. However, the issue of unfair worldwide access to the COVID-19 vaccines has recently sparked significant debate about the vaccine industry’s role. Recent data demonstrated that the system’s perceived unfairness with the masses is behind the growing populist anti-vaccine movements worldwide. The association between populism and antivaccine attitudes has been reported at country and individual levels. The anti-science attitudes behind vaccine hesitancy emerge when the scientist is not found credible due to the suspicion that they had monetary investments in pharmaceutical companies. Here, I argue that the obscurity of the vaccine market, but also its unfairness, are important factors contributing to vaccine hesitancy. The purpose of this commentary is to stimulate a review of current market regulations and to improve its transparency and fairness, particularly in the context of public health emergencies. By doing so, a new pandemic would find us better prepared. The general population and much of the healthcare community often ignore the years of dedicated work and substantial public funding that enabled the discovery and design of vaccines. Conversely, pharmaceutical companies often over-emphasize their investments in research and development. A decade ago, Marcia Angell provided a detailed breakdown of pharmaceutical expenses, revealing that marketing and administration costs were 2.5 times higher than research and development expenses; recently, Olivier Wouters confirmed the high expenditures of the pharmaceutical industry in lobbying and political campaign contributions. In this commentary, I will present the cases of HPV and COVID-19 vaccines as examples of when vaccines, instead of being public health goods, became market goods, creating large inequities and health costs. This failure is a structural cause behind more ideological vaccine hesitancy, less studied so far.

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“…Trays were covered with fitted lids and incubated at 37 • C. To quantify melanisation, brightfield images of individual larvae were analysed using the software IM-PACT2AMR (https://github.com/ashsmith88/IMPACT2AMR_galleria_imaging (accessed on 17 November 2022)), which identifies larvae within a boundary box and quantifies pixel brightness (inversely proportional to melanisation) within the boundary. Treatment groups (1)(2)(3)(4)(5)(6)(7)(8) were distributed evenly across the plates to account for differences in light exposure across the plate that could affect melanisation scores (Table S3a,b). Survival and melanisation were recorded at 0, 14, 17, 21 and 24 h. Kaplan-Meier survival curves for the G. mellonella infection assays were plotted with the Survival Analysis Package v. 3.5-5 [46] using the survfit function and the survdiff function to test the difference between curves with a log rank test.…”

Section: In Vivo Galleria Mellonella Infection Assaymentioning

confidence: 99%

“…In 2019 there were an estimated 1.27 million deaths directly attributable to bacterial AMR, greater than the combined number of deaths from malaria and HIV/AIDS for that year [ 2 ]. Whilst there are innovative approaches to finding novel antibiotics [ 3 , 4 ] and progressive economic models to incentivise antibiotic development [ 5 , 6 ], developing new antibiotics remains scientifically and financially challenging. With the rapid rise of AMR there is an urgent need for new therapeutic options.…”

Section: Introductionmentioning

confidence: 99%

The Citizen Phage Library: Rapid Isolation of Phages for the Treatment of Antibiotic Resistant Infections in the UK

Fletcher,

Manley,

Fitch

et al. 2024

Microorganisms

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Antimicrobial resistance poses one of the greatest threats to global health and there is an urgent need for new therapeutic options. Phages are viruses that infect and kill bacteria and phage therapy could provide a valuable tool for the treatment of multidrug-resistant infections. In this study, water samples collected by citizen scientists as part of the Citizen Phage Library (CPL) project, and wastewater samples from the Environment Agency yielded phages with activity against clinical strains Klebsiella pneumoniae BPRG1484 and Enterobacter cloacae BPRG1482. A total of 169 and 163 phages were found for K. pneumoniae and E. cloacae, respectively, within four days of receiving the strains. A third strain (Escherichia coli BPRG1486) demonstrated cross-reactivity with 42 E. coli phages already held in the CPL collection. Seed lots were prepared for four K. pneumoniae phages and a cocktail combining these phages was found to reduce melanisation in a Galleria mellonella infection model. The resources and protocols utilised by the Citizen Phage Library enabled the rapid isolation and characterisation of phages targeted against multiple strains. In the future, within a clearly defined regulatory framework, phage therapy could be made available on a named-patient basis within the UK.

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Optimal subscription models to pay for antibiotics

Cited by 5 publications

References 26 publications

Economic evaluation of antimicrobial resistance in curable sexually transmitted infections; a systematic review and a case study

Economic evaluation of antimicrobial resistance in curable sexually transmitted infections; a systematic review and a case study

How Did We Get Here: The Best Vaccines Ever Facing the Highest Public Hesitancy?

The Citizen Phage Library: Rapid Isolation of Phages for the Treatment of Antibiotic Resistant Infections in the UK

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