Antibiotics have played a significant role in expanding life expectancy over the last 100 years. However, bacteria have evolved and developed the genetic machinery to adapt and resist antimicrobials, threatening to make antibiotics ineffective – known as antimicrobial resistance (AMR). The problem of AMR was already evident when penicillin was isolated in the 1930s by Alexander Fleming. Fleming himself observed that his bacterial cultures quickly developed resistance, and in 1945 he warned that the misuse of penicillin could lead to the selection of resistant bacteria.
If the problem is not contained, the resulting costs could be as much as 10 million deaths and £100 trillion annually by 2050.
Understanding Patient Preferences
Researchers conducted a study in the UK Funded by a Wellcome trust seed award to understand how people would respond to different options for addressing AMR. In other words, how would different strategies impact attempts to optimize the use of antibiotics? Beyond that, how much would society be willing to pay for future research in AMR and strategies to optimize the use of antibiotics in both health and agriculture sectors?
Survey respondents were asked to imagine having a sore throat, fever with a temperature of 38°C (100.4°F), discomfort or general pain, cough, and difficulty sleeping. They were then asked to choose between two different hypothetical treatments and the option of forgoing antibiotic treatment and not going to the doctor. Researchers also explored whether preferences would change based on different risk levels of actually having a bacterial infection that needed to be treated with antibiotics.
Results of this discrete choice experiment show that older respondents, respondents who were married, those who have children in their household, those with a higher education degree, or those who considered the AMR threat very serious for future generations were more likely to always select the “no doctor/go without antibiotics” alternative in the questionnaire.
Preference analysis generally indicated that respondents were more concerned about the potential risk of very high levels of AMR in 2050 if there was a lower risk of having an infection. The higher the risk of infection, the lower the respondents ranked the importance of high risk of AMR in 2050. In addition, respondents placed more importance on the number of days needed to recover if there was a lower risk of bacterial infection.
More than 50% indicated they would vote to fund research to improve the efficacy of antibiotic use.
This research suggests that understanding the risks of both infections and AMR will impact how people use antibiotics. Understanding the societal preferences identified by this patient preference research can help policymakers developing strategies to combat AMR.
Dorgali MV, Longo A, Vass C, Shields G, Harrison R, Boeri M. Exploring Antimicrobial Resistance (AMR) from a societal perspective: preferences and welfare impacts in the United Kingdom. Poster presented at the Virtual ISPOR Europe 2020; November 2020. [abstract] Value Health. 2020 Dec; 23(S2).