A SYSTEMATIC REVIEW AND FUTURE DIRECTION OF INCENTIVE MECHANISMS TO DEVELOP NEW ANTIBIOTICS

Background and aims: Drug–resistant diseases kill around 700.000 people each year, but this number will be escalated to 10 million a year by 2050 if we take no action in the short run. Governments around the world want that antimicrobial resistance (AMR) is the next health crisis after COVID–19. Despite the obvious need for more drugs, fewer antibiotics researching the market because of the non-profitable market of antibiotics and the increased cost of the development. Given this market failure and the multi–layered challenges, action is needed to stimulate the R&D of new antibiotics. This systematic review aimed to understand which antibiotic incentive strategies are most recommended within the literature by also suggesting a possible mechanism to address funding and resource support. Methods: To identify relevant studies, databases including MEDLINE (Via EBSCOhost Databases), Pubmed (Via National Library of Medicine), CINAHL Plus (Via EBSCOhost Research Databases) and ScienceDirect were searched. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Critical analysis of including articles were analyzed using the assessment framework developed by Renwick. An individual score by which we were able to quantify the advantages and notable shortcomings each. Results: A total of 54 unique incentive strategies were identified from the literature search. The strategies encompassed pull and push based incentives and policies as well as multifaceted models including the novel subscription model and hybrid mechanisms combining multiple incentives and policies. Conclusion: Based on our findings, we propose that neither push nor pull financial mechanisms alone are enough to stimulate R&D in antibiotics. Our suggestion is to combine different aspects of different models to match the needs and the characteristics of each country or union of countries. A hybrid model called Option Market for Antibiotics is suggested while international cooperation needed to tackle this issue