As depicted in Table 3, there are a number of approaches that might prolong the useful lives of antibacterial drugs through stewardship, appropriate use, and conservation. All of these goals are important for public health. However, from the perspective of the antibacterial drug developer, all of these programs reduce demand for their products and therefore reduce incentives to create new drugs. Some of these incentives include the following:
- Education campaigns – Many patients continue to believe that antibacterial drugs are effective against common non-bacterial conditions (such as colds and influenza) and therefore seek antibacterial drug prescriptions from their doctors to treat these viral infections. Correcting these widespread false beliefs through better public education could help to decrease the demand for antibacterial drugs and slow the development of resistance.
- Improvements in hospital infection control – Reducing healthcare-associated infections can decrease both antibacterial demand and the incidence of antibacterial drug resistance.
- Vaccination promotion – Vaccines for both bacterial and viral diseases, such as the pneumococcal conjugate vaccine and the influenza vaccine, can reduce disease incidence, bacterial coinfections, antibacterial drug demand, and antibacterial drug resistance, while also providing spillover benefits to non-vaccinated individuals, whose risk of infection decreases as more of the population are vaccinated. Direct subsidies for research into new antibacterial vaccines would also reduce the demand for antibacterials drugs, delaying resistance.
- Better monitoring and reporting of infection rates and antibacterial drug resistance (AR) – Surveillance of antibacterial drug resistance (AR) will improve understanding of the impacts of changes in antibacterial drug prescribing patterns, help identify new resistance mechanisms and outbreaks of resistant pathogens, assist in development of public health guidelines for infection control, and allow better education of health care providers and patients regarding AR (Laxminarayan & Malani, 2007; Mossialos, et al., 2010; Ming, Chen, Miller, Sexton, & Anderson, 2012).
- Performance- and value-based reimbursement schemes – Under a performance-based scheme, hospital reimbursement would be tied to levels of infection and drug resistance. Alternatively, in a value-based reimbursement approach, existing insurance plans would implement a system that provides reimbursement for antibacterial drugs according to their health impact, encouraging manufacturers to set their price based on the calculated impact, with more effective drugs being priced higher.
As noted earlier, the conservation incentives have the effect of reducing antibacterial drug developer revenues and thus can be examined using the analytical framework developed by simply applying a percentage reduction to the total developer revenue scheme or varying percentage reductions to annual developer revenues. We did not, however, analyze conservation incentives in this study.