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14.
February
2019.
Study finds potential value in withholding some new antibiotics until major inf
Study finds potential value in withholding some new antibiotics until major infection outbreak
14 February 2019
The search for new antibiotics to tackle increasingly-resistant infections is a priority for health professionals and governments around the world.
14 February 2019
The search for new antibiotics to tackle increasingly-resistant infections is a priority for health professionals and governments around the world.
But a study by researchers has suggested there could be a benefit in withholding widespread use of some new antibiotics until the outbreak of a major pandemic.
The study’s authors cite the 1918 Spanish Flu pandemic, which is estimated to have killed 50 to 100 million people worldwide, where bacterial infection was shown to be a complicating factor in 95% of post-mortem samples.
Many of these deaths, they claim, might have been prevented had antibiotics been available.
Today countries have put in place measures to tackle future pandemics, such as infection control procedures, vaccines and stockpiles of antibiotics and antivirals.
However, researchers at the University of Strathclyde say growing resistance to antibiotics may render such stockpiles useless. They highlight that just two new classes of antibiotic have been introduced since the 1970s.
Lead author Dr Itamar Megiddo, of the Department of Management Science at the University of Strathclyde, said: “Experts globally are pushing for a delinked model for antibiotics, in which healthcare systems pay a flat annual fee instead of pharmaceutical revenues relying on volume of sales.
“This provides the healthcare system the opportunity to devise strategies for antibiotics use. For certain antibiotics, it may be obvious that introducing the antibiotic today will be optimal, but in other cases, comparing the values an antibiotic provides can guide investment in novel agents as well as strategies on how to use them.”
The UK has recently launched a five-year plan to tackle antimicrobial resistance, which seeks to restrict the use of drugs and provide greater incentives for pharmaceutical companies to develop new ones. The approach includes the use of electronic prescriptions and moving to a delinked model.
Dr Megiddo said: “It is important that we understand what the value of an antibiotic is.
“Our study investigated the value of delaying the introduction of a hypothetical novel antibiotic so we do not incentivise narrowing investment in antibiotics to ones that provide immediate value.
“If we presuppose a strategy of immediate widespread use of newly-discovered antibiotics we leave the population unprepared for outbreaks caused by resistant pathogens.”
The study used ‘real options theory’ to assess the trade-offs to estimate the value of investing in, developing and conserving a hypothetical antibiotic to mitigate the burden of bacterial infections during a pandemic influenza caused by a strain of S. aureus resistant to all oral options except for the hypothetical drug.
The researchers found that by protecting their hypothetical oral antibiotic until detecting pandemic influenza can provide value through lives saved, hospitalisations averted and stress on the economy more widely. Whereas if the outbreak is mild or the pathogen is not resistant to current drugs, it would be better to either use it earlier or wait for a more significant pandemic.
Dr Megiddo, said: “Our results indicated withholding widespread use of the hypothetical antibiotic would be a preferred strategy if the annual benefits during the pandemic are at least 1,000 times greater than the annual prepandemic benefits.
“In the mild and severe pandemic scenarios, the annual benefits during the pandemic would need to be at least 380 and 3,000 times greater than the prepandemic ones, respectively.”
The authors say that, while their study was a simplification of potential scenarios, further analysis on a case-by-case basis could guide investment in novel antibiotics as well as strategies on how to use them.
Dr Megiddo added: “The results we present in our worked example suggest that considering the option value of delaying introducing antibiotics is important for making decisions to invest in antibiotics.
“Governments globally will need to consider this value as we move to new business models for encouraging antibiotics research and development and promoting stewardship.
“Secondary infections caused by a significant influenza pandemic today could be catastrophic. If we wait until no options are available before deciding to invest in novel drugs we may be too late.”
The study, published in the journal Health Economics, was funded by the EU Framework 7 programme as part of the ‘Driving re-investment in R&D and responsible anti-biotic use’ initiative.
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Link to research paper: https://onlinelibrary.wiley.com/doi/full/10.1002/hec.3867
Stuart Forsyth
Link to research paper: https://onlinelibrary.wiley.com/doi/full/10.1002/hec.3867
Stuart Forsyth
Corporate Communications Manager
Media and Corporate Communications
University of Strathclyde
Tel: 44 (0) 141 548 4373
Mob: 07976 660 433
Email: stuart.m.forsyth@strath.ac.uk
Twitter: @UniStrathNews