Discrete choice experiment to investigate preferences for incentives to promote antimicrobial research and development

Abstract

Without intervention, experts predict that antimicrobial resistance will rank among leading drivers of mortality by 2050. New drugs are desperately needed, but given the lengthy development timelines for antimicrobial research and development (R&D), existing economic incentives fail to support a robust pipeline of new products. This study aims to elicit the preferences of stakeholders for adequate antimicrobial R&D incentive programs. A discrete choice experiment was conducted in which stakeholders (representatives from small or medium and large pharmaceutical companies, academics, clinicians, and policy makers) were asked in 12 choice tasks to select their preferred incentive combinations among two hypothetical options, differing in five attributes: form of monetary incentive, total amount of monetary incentive, market exclusivity extensions, transferable exclusivity extensions vouchers, and priority review vouchers. A subgroup analysis comprising only participants from the pharmaceutical industry was also conducted. A total of 50 stakeholders (including 24 from the pharmaceutical industry) completed the survey in full. Participants preferred longer transferable exclusivity extensions and larger amounts of monetary rewards. The levels that were perceived as having the highest utility were $1 billion as total amount of incentives and transferable exclusivity extension for 18 months. The subgroup analysis provided similar findings. This study suggests that survey participants viewed transferable exclusivity vouchers for an 18-mo term and higher ($1 billion) monetary rewards as the preferred incentives to promote antimicrobial R&D. Further work is needed to design specific incentives and ensure they are implemented effectively.