DP18358 Antibiotic Demand in the Presence of Antimicrobial Resistance
Antimicrobial resistance (AMR) increases hospital stays, medical costs and mortality. Antibiotic consumption and the resulting selective pressure on bacteria can create AMR. We study the role of AMR in changes in prescriptions of antibiotics in France for treating bladder inflammation (cystitis) using a representative sample of general practitioners between 2002 and 2019. We propose a decision model for prescriptions when point-of-care rapid bacterial or susceptibility testing is performed or not, which affects patient-specific infection susceptibility information. The effects of resistance on demand and substitution behavior are identified by controlling for the endogeneity of resistance via the use of antibiotic sales in veterinary medicine. As resistance increases, physicians substitute other drugs, and we test whether physicians consider predictable resistance evolution in their decisions. We perform counterfactual analysis to assess the impact of decreasing the use of antibiotics in animals and limiting the use of fluoroquinolone to treat cystitis. Both policies reduce resistance to fluoroquinolones but have opposite effects on drug substitution and consumer surplus. Finally, we propose a method to evaluate the value of rapid bacterial detection and antibiotic susceptibility testing.
