Estimating the Return on Investment of Pull Incentive Policies for New Antimicrobials: Insights for the EU and Beyond

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Key Messages: 

• Antimicrobial resistance is an increasing global threat and the world needs a reliable pipeline of new, effective antimicrobials as a crucial element of managing it.

• The antimicrobial market is characterised by a pervasive market failure where developers are unable to realise a sufficient return on investment once a new drug is approved, despite the high-societal value of new antimicrobials coming to market.

• Pull incentives policies, which offer alternative and/or additional methods of rewarding innovators for bringing high-value antimicrobials to market offer a well evidenced and widely supported mechanism to strengthen the antimicrobial pipeline through sufficiently awarding developers of new therapies. 

• Building on previous analyses at the EU and G7 levels, we examined the expected return on investment for national governments investing in a new incentive scheme targeting the development of 18 new drugs over a 30-year time horizon.

• Our analysis show that for all countries considered, purchasing antimicrobials through a de-linked incentive program gives a robustly positive return on investment over both short- and long-term horizons, ranging from 1.3:1 to 4.6:1 over a 10-year horizon and from 6.1:1 to 21:1 over a 30-year horizon. This estimate conservatively only includes direct clinical benefits to patients and reduced healthcare costs, and should hence be considered as a lower bound.

• Based on this research, we created a dashboard which allows for the return on investment of a pull incentive scheme to be calculated under a wide range of assumptions.