Antibiotic Demand in the Presence of Antimicrobial Resistance

Résumé

Antimicrobial resistance (AMR) increases hospital stays, medical costs and mortality. Antibiotic consumption and resulting selective pressure on bacteria can create AMR. We study the role of AMR on changes in prescriptions of antibiotics in France for treating bladder inflammation (cystitis) using a representative sample of general practitioners between 2002 and 2019. Effects of resistance on demand and substitution behavior are identified via a random coefficient logit model, controlling for the endogeneity of resistance using antibiotics sales in veterinary medicine. As resistance increases, physicians substitute to other drugs, and we test whether physicians consider predictable resistance evolution in their decisions. We perform counterfactual analysis assessing the impact of decreasing veterinary use of antibiotics and limiting fluoroquinolone use to treat cystitis. Both policies reduce resistance against fluoroquinolones but have opposite effects on substitution behavior and consumer surplus. Finally, we propose a method for the optimal pricing of rapid bacterial detection and antibiotic susceptibility testing.

Codes JEL

I10: General
D12: Consumer Economics: Empirical Analysis
L11: Production, Pricing, and Market Structure • Size Distribution of Firms
C25: Discrete Regression and Qualitative Choice Models • Discrete Regressors • Proportions