Reimbursement Incentives for Antibiotics in Eleven European Countries: A Comparative Analysis

OBJECTIVES: The World Health Organization identified antimicrobial resistance (AMR) as a top five global health threat in 2019. However, the lack of market recognition for the value of antibiotics targeting antimicrobial resistance (AMR), combined with AMR stewardship, disincentivizes research and development (R&D) in this critical area. This research aims to assess and compare pricing and reimbursement (P&R) incentives for antibiotics to tackle AMR across eleven European countries: United Kingdom (UK), France (FR), Germany (DE), Sweden (SE), Spain (ES), Italy (IT), Norway (NO), Denmark (DK), Finland (FI), Netherlands (NL), and Belgium (BE).

METHODS: A keyword search and review of health technology assessment (HTA) agencies’ websites, HTA documents on antibiotics, and governmental organization websites was conducted to extract data on AMR policies and antibiotic-specific P&R incentives in eleven countries. The extracted data was used to assess market maturity. Specific P&R incentives signaled the most mature markets, while national action plans (NAPs) indicated less mature markets in terms of effectively supporting and facilitating access to antibiotics.

RESULTS: Out of the 11 countries investigated, only 4 (UK, SE, DE, FR) have specific P&R incentives to improve patient access to antibiotics addressing AMR. The UK and SE are the most advanced, implementing antibiotic-specific value assessment frameworks and novel purchasing agreements. DE and FR provide pricing benefits for antibiotics through modifications of their existing HTA frameworks' reimbursement routes. However, they lack novel purchasing models. The remaining seven countries (ES, IT, NO, DK, FI, NL, BE) have NAPs focused on AMR but lack specific access pathways for antibiotics.

CONCLUSIONS: The UK and SE lead efforts to incentivize antibiotic commercialization through improved access conditions. However, most EU countries investigated lack specific P&R incentives for antibiotics that address AMR. To combat AMR effectively, establishing favorable reimbursement environments is crucial to foster innovation in antibiotic R&D.