Our ability to treat common bacterial infections with antibiotics goes back only 65 years. However, the authors of this report make it clear that sustaining a supply of effective and affordable antibiotics cannot be without changes to the incentives facing patients, physicians, hospitals, insurers, and pharmaceutical manufacturers. In fact, increasing resistance to these drugs is already exacting a terrible price. Every day in the United States, approximately 172 men, women, and children die from infections caused by antibiotic-resistant bacteria in hospitals alone. Beyond those deaths, antibiotic resistance is costing billions of dollars through prolonged hospital stays and the need for doctors to resort to ever more costly drugs to use as substitute treatments. Extending the Cure presents the problem of antibiotic resistance as a conflict between individual decision makers and their short-term interest and the interest of society as a whole, in both present and future: The effort that doctors make to please each patient by prescribing a drug when it might not be properly indicated, poor monitoring of discharged patients to ensure that they do not transmit drug-resistant pathogens to other persons, excesses in the marketing of new antibiotics, and the broad overuse of antibiotics all contribute to the development and spread of antibiotic-resistant bacteria. The book explores a range of policy options that would encourage patients, health care providers, and managed care organizations to serve as more responsible stewards of existing antibiotics as well as proposals that would give pharmaceutical firms greater incentives to develop new antibiotics and avoid overselling. If the problem continues unaddressed, antibiotic resistance has the potential to derail the health care system and return us to a world where people of all ages routinely die from simple infections. As a basis for future research and a spur to a critically important dialogue, Extending the Cure is a fundamental first step in addressing this public health crisis. The Extending the Cure project is funded in part by the Robert Wood Johnson Foundation through its Pioneer Portfolio.
The book examines applications in two disparate fields linked by the importance of valuing information: public health and space. Researchers in the health field have developed some of the most innovative methodologies for valuing information, used to help determine, for example, the value of diagnostics in informing patient treatment decisions. In the field of space, recent applications of value-of-information methods are critical for informing decisions on investment in satellites that collect data about air quality, fresh water supplies, climate and other natural and environmental resources affecting global health and quality of life.
Artemisinin-based combination treatments (ACTs) are seen as an important tool in the global effort to roll back malaria. With rapidly increasing parasite resistance to chloroquine in many parts of the world, there is greater international recognition of the need for both a different antimalarial and a coordinated malaria treatment strategy to ensure that resistance does not needlessly cut short the useful therapeutic life of any successor drug to chloroquine. The effectiveness of antimalarial drugs is a global public good, of particular value in malarious regions that also are among the most economically impoverished parts of the world. Inappropriate drug use in neighboring countries reduces the incentive of any given country to deploy drug regimens that may be rapidly undermined by resistance originating outside their borders. Therefore, a case can be made for globally coordinated action to protect the effectiveness of these valuable drugs. Translating this case to one for a global subsidy is not straightforward. On the one hand, in the absence of such a subsidy to ensure that ACTs are comparably priced to monotherapies, increasing monotherapy of artemisinin and other antimalarials that would be used along with artemisinin in ACT will hasten the demise of this drug. On the other hand, a global subsidy would greatly increase the use and potential misuse of ACTs and could result in resistance emerging at a more rapid rate. This study finds that a subsidy to ACTs is likely to slow the rate of emergence of resistance to artemisinin and partner drugs, even if such a subsidy were to increase the use of ACTs significantly. This conclusion is robust to alternative assumptions regarding the responsiveness of demand to the lower price for ACTs and a wide range of epidemiological and economic parameters. However, the simulation results show that a subsidy for two or more ACT combinations is likely to be much more cost-effective than a subsidy to a single ACT. The only consideration is that the drugs used as partners to artemisinin be unrelated to each other and to artemisinin in mechanism of action and in genetic bases of resistance, so that a single mutation cannot encode resistance to both components. Such a subsidy program for ACTs, administered globally, that reduces reliance on any single combination, and discourages monotherapy, not only of artemisinin but of any effective antimalarial that could potentially be used as partner drug with artemisinin, is likely to be effective (and cost-effective) both in buying time for ACTs and in saving lives "--World Bank web site.
Our ability to treat common bacterial infections with antibiotics goes back only 65 years. However, the authors of this report make it clear that sustaining a supply of effective and affordable antibiotics cannot be without changes to the incentives facing patients, physicians, hospitals, insurers, and pharmaceutical manufacturers. In fact, increasing resistance to these drugs is already exacting a terrible price. Every day in the United States, approximately 172 men, women, and children die from infections caused by antibiotic-resistant bacteria in hospitals alone. Beyond those deaths, antibiotic resistance is costing billions of dollars through prolonged hospital stays and the need for doctors to resort to ever more costly drugs to use as substitute treatments. Extending the Cure presents the problem of antibiotic resistance as a conflict between individual decision makers and their short-term interest and the interest of society as a whole, in both present and future: The effort that doctors make to please each patient by prescribing a drug when it might not be properly indicated, poor monitoring of discharged patients to ensure that they do not transmit drug-resistant pathogens to other persons, excesses in the marketing of new antibiotics, and the broad overuse of antibiotics all contribute to the development and spread of antibiotic-resistant bacteria. The book explores a range of policy options that would encourage patients, health care providers, and managed care organizations to serve as more responsible stewards of existing antibiotics as well as proposals that would give pharmaceutical firms greater incentives to develop new antibiotics and avoid overselling. If the problem continues unaddressed, antibiotic resistance has the potential to derail the health care system and return us to a world where people of all ages routinely die from simple infections. As a basis for future research and a spur to a critically important dialogue, Extending the Cure is a fundamental first step in addressing this public health crisis. The Extending the Cure project is funded in part by the Robert Wood Johnson Foundation through its Pioneer Portfolio.
Artemisinin-based combination treatments (ACTs) are seen as an important tool in the global effort to roll back malaria. With rapidly increasing parasite resistance to chloroquine in many parts of the world, there is greater international recognition of the need for both a different antimalarial and a coordinated malaria treatment strategy to ensure that resistance does not needlessly cut short the useful therapeutic life of any successor drug to chloroquine. The effectiveness of antimalarial drugs is a global public good, of particular value in malarious regions that also are among the most economically impoverished parts of the world. Inappropriate drug use in neighboring countries reduces the incentive of any given country to deploy drug regimens that may be rapidly undermined by resistance originating outside their borders. Therefore, a case can be made for globally coordinated action to protect the effectiveness of these valuable drugs. Translating this case to one for a global subsidy is not straightforward. On the one hand, in the absence of such a subsidy to ensure that ACTs are comparably priced to monotherapies, increasing monotherapy of artemisinin and other antimalarials that would be used along with artemisinin in ACT will hasten the demise of this drug. On the other hand, a global subsidy would greatly increase the use and potential misuse of ACTs and could result in resistance emerging at a more rapid rate. This study finds that a subsidy to ACTs is likely to slow the rate of emergence of resistance to artemisinin and partner drugs, even if such a subsidy were to increase the use of ACTs significantly. This conclusion is robust to alternative assumptions regarding the responsiveness of demand to the lower price for ACTs and a wide range of epidemiological and economic parameters. However, the simulation results show that a subsidy for two or more ACT combinations is likely to be much more cost-effective than a subsidy to a single ACT. The only consideration is that the drugs used as partners to artemisinin be unrelated to each other and to artemisinin in mechanism of action and in genetic bases of resistance, so that a single mutation cannot encode resistance to both components. Such a subsidy program for ACTs, administered globally, that reduces reliance on any single combination, and discourages monotherapy, not only of artemisinin but of any effective antimalarial that could potentially be used as partner drug with artemisinin, is likely to be effective (and cost-effective) both in buying time for ACTs and in saving lives "--World Bank web site.
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