Hillock Nadine T, Merlin Tracy L, Karnon Jonathan, Turnidge John, Eliott Jaklin
School of Public Health, University of Adelaide, Adelaide SA 5000, Australia.
College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia.
JAC Antimicrob Resist. 2020 May 10;2(2):dlaa023. doi: 10.1093/jacamr/dlaa023. eCollection 2020 Jun.
There is a disparity in the economic return achievable for antimicrobials compared with other drugs because of the need for stewardship. This has led to a decline in pharmaceutical companies' willingness to invest in the development of these drugs and a consequent global interest in funding models where reimbursement is de-linked from sales.
To explore the perspective of stakeholders regarding the feasibility of de-linked reimbursement of antimicrobials in Australia.
Semi-structured interviews were conducted with 18 participants sourced from the pharmaceutical industry and individuals representing public-sector payers or regulators. Interviews were transcribed verbatim, coded and thematically analysed using the framework method.
Five key themes were identified in the interviews: funding silos are a barrier to de-linking reimbursement; varying levels of supporting evidence are (currently) required for funding depending upon setting; funding status or cost is used as a stewardship tool; a de-linked model may cost more; and concerns regarding governance and access to antimicrobials exist in the private sector.
Australia's current multi-tiered funding of medicines across different levels of government was perceived as a barrier to de-linked reimbursement. Participants felt that the responsibility for antimicrobial funding and stewardship should be integrated and centralized. Implementing a nationally funded de-linked reimbursement model for new antimicrobials would require a review of funding decision-making criteria, given that most MDR infections are off-label indications and could not then be funded through the Australian Pharmaceutical Benefits Scheme. Findings from this study could be applicable to other countries with reimbursement frameworks similar to Australia.
由于需要进行管理，与其他药物相比，抗菌药物可实现的经济回报存在差异。这导致制药公司投资开发这些药物的意愿下降，进而引发了全球对报销与销售脱钩的资助模式的关注。
探讨利益相关者对澳大利亚抗菌药物报销脱钩可行性的看法。
对来自制药行业以及代表公共部门付款方或监管机构的18名参与者进行了半结构化访谈。访谈内容逐字记录、编码，并使用框架法进行主题分析。
访谈中确定了五个关键主题：资金孤岛是报销脱钩的障碍；根据情况不同，（目前）资助所需的支持证据水平各异；资助状态或成本被用作管理工具；脱钩模式可能成本更高；私营部门存在对治理和抗菌药物获取的担忧。
澳大利亚目前由不同层级政府对药品进行的多层级资助被视为报销脱钩的障碍。参与者认为抗菌药物资助和管理的责任应整合并集中。鉴于大多数耐多药感染属于超适应症用药，无法通过澳大利亚药品福利计划获得资助，因此为新型抗菌药物实施国家资助的报销脱钩模式需要对资助决策标准进行审查。本研究结果可能适用于其他报销框架与澳大利亚类似的国家。
