Background

Antimicrobial resistance is a growing global healthcare priority requiring continuous development of new antimicrobials, which continues to be challenging and leading to disinvestment for decades. This study aimed to understand the differences in observed willingness to pay by healthcare systems between antimicrobials and other curative therapies reimbursed in Spain, by analysing the cost of treatment to achieve a cure, across different therapeutic areas.

Method

All medicines approved by the European Medicines Agency until December 2020 were classified as curative or non-curative and reimbursement for each of their approved indications for adults in Spain. Generics, biosimilars, preventive and chronic treatments not leading to potential cure/eradication, were excluded. For each drug/indication (and genotype/cirrhotic state for Hepatitis C), cure rates were taken from the pivotal clinical trials. The cost of treatment to achieve a cure was calculated using the prescribing information, national published price lists including concomitant medication. The study methodology and design was validated by a board of external experts. The cost per cure for each medicine and indication was calculated and analysed per therapeutic area.

Results

Twenty-four curative treatments (33 indications) were identified in Spain, predominantly in hemato-oncology and anti-infectives. The cost/cure was substantially higher for oncology treatments (n=7; mean:278,479€/cure; range:€53,879-790,812€/cure), followed by hepatitis C treatments (n=7; mean:43,952€/cure; range:25,900€-104,599€/cure); multidrug resistant tuberculosis (n=1; 22.885€/cure) antifungals (n=1; 22,052€/cure) and antimicrobials (n=7; mean:2,275€/cure; range:108€-8,042€/cure).

Conclusion

Despite the multiple limitations of this research (use of list prices, different cure definitions, different healthcare system burden, unmet need and populations affected), it highlights inconsistencies in the willingness to pay for curative treatments in different therapeutic areas. It is particularly low for antimicrobials, which could contribute to the low investment in this therapy area. Similar results were observed in other European countries. Further research is required to better understand the reasons and implications of this findings.