Estimating the Magnitude of a Pull Incentive for Antibiotic Development Using the STEDI Value Framework: An Example From Spain
Author(s)
Maria Gheorghe, PhD1, Luis Martínez-Martínez, MD, PhD2, Sonia Luque, PhD, Pharm D3, Ricard Ferrer, MD, PhD4, ALFONSO DE LOSSADA JUSTE, Sr., PharmD5, Marta Maroto-Diaz, MPH, PhD5, Carmen de Ceano-Vivas, BSc5, Yolanda Moreno, BSc5, James Dennis, BSc6, Silviya Nikolova, PhD6, Edward I. Broughton, BSc, MPH, PhD7;
1Pfizer Inc, Bucharest, Romania, 2University Hospital Reina Sofia, Cordoba, Spain, 3Hospital del Mar, Pharmacy Department, Barcelona, Spain, 4Vall d’Hebron Hospital Universitari, Intensive Care Department, Barcelona, Spain, 5Pfizer SLU, Madrid, Spain, 6Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom, 7Pfizer Inc, New York, NY, USA
1Pfizer Inc, Bucharest, Romania, 2University Hospital Reina Sofia, Cordoba, Spain, 3Hospital del Mar, Pharmacy Department, Barcelona, Spain, 4Vall d’Hebron Hospital Universitari, Intensive Care Department, Barcelona, Spain, 5Pfizer SLU, Madrid, Spain, 6Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom, 7Pfizer Inc, New York, NY, USA
OBJECTIVES: Pull incentives, such as the UK’s Antimicrobial Products Subscription Model, are intended to encourage antimicrobial development by delinking revenue from sales volume whilst also supporting antimicrobial stewardship. Similar initiatives are being considered in the US (PASTEUR Act), the EU, Canada and Japan. A fully delinked pull incentive is estimated at $4.2 billion, globally per antimicrobial drug. This study aimed to estimate the pull value of a novel antibiotic (aztreonam-avibactam [ATM-AVI]) to Spain’s healthcare system, using transmission and diversity value from the STEDI (spectrum, transmission, enablement, diversity and insurance) framework. ATM-AVI is approved in Europe in adult patients for treatment of complicated intra-abdominal infection (cIAI); hospital-acquired pneumonia, including ventilator-associated pneumonia (HAP/VAP); complicated urinary tract infection, including pyelonephritis and aerobic gram-negative infections with limited treatment options.
METHODS: Transmission and diversity value were estimated with population-level dynamic transmission modeling, where ATM-AVI was added to current treatment strategies for suspected metallo-beta-lactamase-producing Enterobacterales HAP/VAP and cIAI. Value was estimated as net monetary benefit (NMB). Quality-adjusted life years (QALYs) gained were valued at a willingness-to-pay threshold of €25,000. Costs included current treatments (excluding ATM-AVI), hospitalization and adverse events (€, 2024). Outcomes were estimated over 10 years, aligned with proposed pull incentives.
RESULTS: Introducing ATM-AVI into the Spanish healthcare system for treatment of cIAI and HAP/VAP resulted in an estimated 25,696 QALYs gained (LYs: 29,064) and €122 million in costs saved over ten years. The overall value to the healthcare system considering transmission and diversity value elements from STEDI is estimated at €764 million over ten years.
CONCLUSIONS: Using only transmission and diversity elements of the STEDI framework, this analysis shows that a novel antibiotic (ATM-AVI) provides substantial value to the Spanish healthcare system. Unlocking the value of novel antimicrobials in the context of existing antimicrobial resistance supports policy decisions that incentivize novel antimicrobial development.
METHODS: Transmission and diversity value were estimated with population-level dynamic transmission modeling, where ATM-AVI was added to current treatment strategies for suspected metallo-beta-lactamase-producing Enterobacterales HAP/VAP and cIAI. Value was estimated as net monetary benefit (NMB). Quality-adjusted life years (QALYs) gained were valued at a willingness-to-pay threshold of €25,000. Costs included current treatments (excluding ATM-AVI), hospitalization and adverse events (€, 2024). Outcomes were estimated over 10 years, aligned with proposed pull incentives.
RESULTS: Introducing ATM-AVI into the Spanish healthcare system for treatment of cIAI and HAP/VAP resulted in an estimated 25,696 QALYs gained (LYs: 29,064) and €122 million in costs saved over ten years. The overall value to the healthcare system considering transmission and diversity value elements from STEDI is estimated at €764 million over ten years.
CONCLUSIONS: Using only transmission and diversity elements of the STEDI framework, this analysis shows that a novel antibiotic (ATM-AVI) provides substantial value to the Spanish healthcare system. Unlocking the value of novel antimicrobials in the context of existing antimicrobial resistance supports policy decisions that incentivize novel antimicrobial development.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR143
Topic
Health Policy & Regulatory
Topic Subcategory
Pricing Policy & Schemes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Infectious Disease (non-vaccine)