Updating our Pull Incentives Cost-Benefit Analysis

Link to Dynamic Dashboard

Link to original analysis

As part of the EcoAMR series the Center for Global Development (CGD) recently published a modelling study on the global direct inpatient cost of AMR. The study estimates that drug-resistant infections add up to $66.4 billion per year in global healthcare costs. This figure represents the additional cost compared to treating the same infections if they were drug-susceptible. The study also provides a country-level breakdown for 204 countries, estimating admissions, excess cost per admission, total AMR-related costs, and projections until 2050. 

Figure 1. Estimated direct costs from AMR infections within inpatient settings ($ billion)

Using the results of this study, we have updated the healthcare costs used in our pull incentives cost-benefit analysis dashboard, as we consider CGD’s estimates more rigorous than the previous estimates we used from the OECD. CGD’s approach is the first to combine country-level hospital admission costs with admission numbers to estimate global AMR-related healthcare costs. This ensures that overall healthcare cost estimates align with relevant micro-costing evidence from the literature and also that healthcare cost scenarios align with disease burden scenarios (as estimated by the IHME). There is further detailed discussion about these differences within the study. 

This update strengthens the case for investing in a pull incentive scheme, as it reveals that AMR-attributable healthcare costs may have been underestimated within high-income countries and therefore the return on investment (ROI) from new antibiotics capable of treating these infections is higher than previously thought. Table 1 shows our results for the EU and its four largest countries by GDP. 

Table 1. Comparing the return on investment of pull incentives using CGD estimates vs. our previous estimates

As illustrated in the table, the overall ROI for the EU increases from 6.1 to 7.1 over 10 years and from 28.7 to 32.2 over 30 years, a +16% increase in both cases. The healthcare savings over 10 years are €3.4 billion using CGD’s cost estimates versus only €596 million using the previous estimates at a cost of €2.7 billion. Some EU member states experience larger ROI gains, for instance Germany’s ROI increases from 6.9 to 8.3 over 10 years and from 32.6 to 37.7 over 30 years. This represents a +20% increase driven by healthcare savings of €1,104 million over 10 years compared to €67 million using the previous estimates. Importantly, this suggests that for the EU, investing in pull incentives to obtain antibiotics capable of treating drug-resistant infections can be justified from reduced healthcare costs alone! 

Figure 2. Estimated costs and benefits for implementing pull incentive policies for new antibiotics within a 10 year period 

It is worth noting that our ROI analysis only captures direct patient benefits and healthcare cost reductions—key focuses of traditional Health Technology Assessments (HTAs). In reality, the benefits of such a scheme extend considerably beyond this and include reducing the overall AMR burden, reductions in transmission risk and the insurance value that these products bring. Therefore, the ROI figures that we have given could be considered as a lower bound for the benefits of these programs, with the benefits likely far higher than we have accounted for. 

Note: Our dynamic dashboard is available as a offline Excel file upon request