Are There Inequalities In Willingness To Pay For Antimicrobials And Other Curative Treatments In Different Therapeutic Areas? A Cost Per Cure Analysis Of Recently Approved Medicines In Italy

Antimicrobial resistance is a growing global healthcare priority that requires continuous development of new antimicrobials. However, innovation and development of new antimicrobials continues to be a challenge and multiple companies have disinvested from this area. This study aimed to understand if there are differences in observed willingness to pay healthcare systems between antibacterials and other non-antibiotic curative therapies, by analysing the cost of treatment to achieve a cure for recently reimbursed medicines in the Italy. All new medicines in record approved by European Medicines Agency up to March 2020 were included, and evaluated for each of their approved indications, to be curative or non-curative. Generics, medical devices, procedures, preventive and chronic treatments not leading to potential cure/eradication, were excluded. For each drug and indication, the cost of treatment to achieve a cure was calculated using the prescribing information, national published prices, and weighted by the cure rates achieved for each drug/indication as per endpoints defined in pivotal trials. The cost per cure was then analysed per therapeutic area. 44 curative treatments were identified, predominantly in hemato-oncology and anti-infectives. The cost/cure was substantially higher for oncology treatments (n=20; mean:425,996/cure; range:103,940€–1,307,247€/cure), followed by treatments for hepatitis C (n=6; mean:57,772€/cure; range:26,373€-86,863€/cure); tuberculosis (n=2; mean:45,763€/cure; range:36,548€-54.979€/cure) and antibacterials (n=12; mean:5,508€/cure; range:1,402€-15,059€). The cost/cure for aspergillosis was 83,410€/cure and 3,696€/cure for Clostridium difficile. Despite the limitations of this research (use of published list prices, different definitions of cure, different burden of the condition for the healthcare system, unmet need and populations affected by the condition), it highlights inconsistencies in the willingness to pay for curative treatments in different therapeutic areas, which is particularly low for antibacterials. Further research is required to better understand the reasons and implications of such findings.