Seattle Children's Hospital, Seattle WA, USA.
Healthcare Systems Engineering Institute, Northeastern University, Boston MA, USA.
Appl Ergon. 2021 Jan;90:103242. doi: 10.1016/j.apergo.2020.103242. Epub 2020 Aug 26.
Antibiotic-resistant infections cause over 20 thousand deaths and $20 billion annually in the United States. Antibiotic prescribing decision making can be described as a "tragedy of the commons" behavioral economics problem, for which individual best interests affecting human decision-making lead to suboptimal societal antibiotic overuse. In 2015, the U.S. federal government announced a $1.2 billion National Action Plan to combat resistance and reduce antibiotic use by 20% in inpatient settings and 50% in outpatient settings by 2020. We develop and apply a behavioral economics model based on game theory and "tragedy of the commons" concepts to help illustrate why rational individuals may not practice ideal stewardship and how to potentially structure three specific alternate approaches to accomplish these objectives (collective cooperative management, usage taxes, resistance penalties), based on Ostrom's economic governance principles. Importantly, while each approach can effectively incentivize ideal stewardship, the latter two do so with 10-30% lower utility to all providers. Encouraging local or state-level self-managed cooperative stewardship programs thus is preferred to national taxes and penalties, in contrast with current trends and with similar implications in other countries.
在美国，抗生素耐药性感染每年导致超过 2 万人死亡和 200 亿美元的损失。抗生素处方决策可以被描述为一个“公共地悲剧”的行为经济学问题，因为个人的最佳利益影响人类决策，导致社会对抗生素的过度使用不理想。2015 年，美国联邦政府宣布了一项 12 亿美元的国家行动计划，以对抗耐药性，并在 2020 年前将住院患者的抗生素使用减少 20%，将门诊患者的抗生素使用减少 50%。我们开发并应用了一个基于博弈论和“公共地悲剧”概念的行为经济学模型，以帮助说明为什么理性个体可能不会实践理想的管理，以及如何通过三种具体的替代方法来实现这些目标（集体合作管理、使用税、耐药性罚款），这些方法基于奥斯特罗姆的经济治理原则。重要的是，虽然每种方法都可以有效地激励理想的管理，但后两种方法对所有提供者的效用降低了 10-30%。因此，与当前的趋势相反，与其他国家的情况类似，鼓励地方或州一级的自我管理合作管理计划优于国家税收和罚款。
