INTRODUCTION: There has been significant research into the health economic challenges of antimicrobial development. The challenge and issues are well documented. Following a pilot by NICE, an innovative subscription based payment model is being negotiated for 2 antimicrobial products. There are a number of global collaborations including the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) involving 29 nations and the European commission, aimed at curbing AMR and helping to build a collaborative approach

OBJECTIVES: Given that this is a problem that transcends borders and health systems, we explore the need for a unified approach. We seek to address the conceptual question “Is it sufficient for a number of innovative countries – such as the UK – to develop new assessment and payment models or does there need to be real change at an international level?”.

METHODS: This is a conceptual exploration of whether the market failures will be addressed by individual country initiatives and the imperative for a more global approach. Utilising a targeted literature research, the required market incentives and failures were summarized. The current and proposed approaches for reimbursement of antimicrobials in a selection of countries were evaluated for impact on these challenges and marked subjectively on how far they address the market failures. The implications of having different approaches across markets is discussed in light on its impact on the incentives to develop novel antimicrobials

RESULTS: Countries are developing new and varying approaches even while stating preferences for a collaborative approach.

CONCLUSIONS: We would propose that there does need to be a more global approach to reimbursement and payment for such antimicrobials, if the market failures are to be addressed and to avoid inequality in access to medicines.