Working Paper: CEPR ID: DP18358
Authors: Pierre Dubois; Gke Gkkoca
Abstract: 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.
Keywords: health; physician prescription; antimicrobial resistance; diagnostic test; demand
JEL Codes: I10; D12; L11; C25
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| decreasing veterinary use of antibiotics (Q18) | reduce resistance against fluoroquinolones (Y50) |
| limiting fluoroquinolone use (Y50) | reduce resistance against fluoroquinolones (Y50) |
| decreasing veterinary use of antibiotics (Q18) | opposite effects on substitution behavior (D91) |
| limiting fluoroquinolone use (Y50) | opposite effects on substitution behavior (D91) |
| banning fluoroquinolones (L65) | reduce resistance (D74) |
| banning fluoroquinolones (L65) | increased prescriptions of other antibiotics (L49) |
| rising resistance levels (E65) | changes in prescription behavior (I11) |