• Antibiotics as neglected medicines

    On the frequently interesting E-drug listserve last week, the moderator asked whether antibiotics are neglected essential medicines and reports on GSK’s new campaign to ask for higher reimbursement prices for antibiotics. (Bioworld article here, via e-drug)

    We have substantial evidence that antibiotics are indeed too cheap – that the private value is far less than the social value (shorter Health Affairs version here; much longer Yale J Health Policy Law & Ethics version here).

    The most important proviso – any new incentives must be conditioned on companies meeting antibiotic conservation targets.  Otherwise, we are just boosting incentives to quickly exhaust a precious resource. Unlike all other intellectual property, antibiotic IP is exhaustible.  Unlike every other drug class in history, for anti-infectives we want carefully sequenced innovation.

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    • My sense, without lots of hard data but conditioned by years in the pharmaceutical industry, is that (especially for newer vaccines) current vaccine reimbursement far exceeds the costs of production. Merck is making a LOT of profit on the HPV vaccine. So while the value to society probably exceeds the current costs of vaccines, I see no reason to increase prices. Isn’t that what we want? Benefits exceed cost?

      • I agree the reimbursement on HPV is set high, actually right at the cost-effective threshold, per Kim & Goldie (here: http://www.nejm.org/doi/full/10.1056/NEJMsa0707052).

        But I was talking about J1, systemic antibacterials.

        • Sorry, I saw “antibacterial” but somehow my brain read “vaccine.”

          I participated in the development a novel antibacterial several years ago, and I can say that in that project the pharmaceutical company was very worried about the possibility that the drug would be put on a “reserved” list as a conservation measure. This was a bigger concern than absolute reimbursement rate, since it drastically reduces the number of patients treated. In fact, that is what happened, and I doubt very much the company ever recouped its investment.