The collaborating researcher of the Gaspar Casal Foundation, Jorge Mestre, has presented the projection of this entity according to which, in 2044, the economic impact linked to antimicrobial resistance (AMR) will amount to "between 500 million and 1.3 billion euros" if no decisive measures are adopted against this health challenge.
During the presentation of the report "The cost of AMR in Spain. Recommendations to incentivize the development and access of new antimicrobials", Mestre specified that "the estimated cost in 2025 has been between 500 and 605 million euros". The document was released at the conference "AMR as a health, economic, and legislative challenge. Spain's response to a global threat".
At this meeting, held in the Congress of Deputies at the initiative of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC), Mestre stressed that these figures "undervalue the impact of AMR", which is why he considers that "the traditional volume-based pricing model does not work" presenting "a structural flaw". Against this scheme, he defended the need to resort to "push" and "pull" incentives.
"We need both," he stated, detailing that the former is based on "funding and aid to reduce R&D costs" and is materialized "through research". The latter, he added, comes into play "when it comes to attracting innovation", so that "once you are in the market, it is somehow rewarded".
'Pull' and 'push' incentives and new access models
Based on the quantitative and qualitative analysis included in the report, Mestre argued that, "with these new access and financing models, those that are strategic must be prioritized". Likewise, he stressed the importance of "guaranteeing the sustainability of antimicrobials with mechanisms similar to orphan drugs" and advocated for "establishing multidisciplinary working groups" to "design these incentives and models" and "seek a balance between 'pull' and 'push' incentives".
In parallel, he explained that the Gaspar Casal Foundation has developed "a short-term roadmap" aimed at "strengthening the legislative and regulatory framework". As examples, he cited the Royal Decree on Health Technology Assessment, which "we already have", and the future Royal Decree on Pricing and Financing, "which we will have, we hope".
Among the immediate priorities, he has proposed "improving governance and coordination", "guaranteeing a minimum package of interoperable data", "reducing friction in access with a fast track for priority antimicrobials" and "ensuring that active position in Spain, in the European Union (EU) and globally".
Medium-term recommendations and Spain's role
Looking to the "medium term", the Director of Projects at the Gaspar Casal Foundation, Alicia del Llano, has proposed "a pilot following the subscription model that the United Kingdom started", based on "financing prioritizing one or two reserve antimicrobials and based on a fixed annual payment detached from volume", an initiative already announced by the Ministry of Health.
"The second action would also be to create a functional strategic reserve and all of this, of course, along with the reinforcement of existing clinical protocols and those that have to be produced new". Del Llano added that "selective 'push'", "maintaining Spain's role also as a leader in clinical trials in the area of antimicrobial resistance" and "with all the part of attracting innovation and talent that this leadership entails" would be "interesting".
With a view to "a horizon of more or less five years", she has defended the need to "scale the model" and recalled that AMR "is a structural threat, with a growing impact both in morbidity and mortality, and in associated costs for the National Health System (SNS)". "It is a market failure that requires public intervention to be able to internalize and solve it," she added.
Del Llano insisted that "there is no single incentive". "The combination of incentives is what ensures the correct approach to this problem," she pointed out, emphasizing that "Spain can and must act from now on, as it is doing". To conclude, she warned that "it is predicted that by the year 2050, antimicrobial resistance will displace cancer as the leading cause of death in developed countries".