The decline of the global antibiotic market is threatening the development of new drugs
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The decline of the global antibiotic market is threatening the development of new drugs
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The decline of the global antibiotic market is threatening the development of new drugs.
Since 2001, the market for branded (patented) antibiotics has declined as the market for generic drugs has grown. Global revenues for branded antibiotics peaked at US$21 billion in 2001 and have declined steadily since, to US$8 billion by 2021 (Figure 1a).
This decline was particularly pronounced in the United States, largely due to increased availability of generic medicines and the successful introduction of stewardship programs to combat antibiotic resistance, resulting in lower antibiotic use (Fig. 1b). A similar trend, albeit less pronounced, has emerged in major European markets.
Figure 1 Antibiotic use, expenditure and cost trends from 1999 to 2021
One thing that has not changed is the price of antibiotics: since 1999, the price per standard unit (tablet, capsule or 5ml ampoule/vial/oral suspension) has decreased slightly (Fig. 1c).
And antibiotics are getting cheaper. At the same time, overall usage, as measured by unit sales, increased (Fig. 1c).
Another striking aspect of competition between branded antibiotics and generics is the convergence of standard unit costs (Fig. 1c).
In 1999, the cost per standard unit of branded antibiotics was $1.25 and that of generic antibiotics was $0.19, implying a brand premium of $1.06 per standard unit.
By 2021, the cost per standard unit of branded antibiotics will drop to US$0.88, and the cost of generic drugs will rise to US$0.41, implying a brand premium of US$0.47.
Both standard unit usage and unit price of branded antibiotics have declined, resulting in 2021 revenues of only 43% of 1999 levels.
In conclusion, the global market for antibiotics continues to shift towards lower-cost generics, which benefits access to antibiotics but also raises concerns about inappropriate use and supply chain issues such as shortages due to unsustainable prices.
Furthermore, the sale of branded antibiotics in high-income countries is a key input in financing the R&D of next-generation antibiotics.
Unlike most drug classes, the effectiveness of antibiotics declines over time due to the evolution of bacterial resistance.
New innovative antimicrobials are crucial, but at present, market sales are insufficient to ensure adequate R&D incentives.
Recognizing this problem, the Western Group of Seven recently discussed the need for a global push and pull in antibiotic R&D.
If the goal is to reverse the long-term decline in industry revenues in this segment, an additional $13 billion per year will be needed globally to restore brand revenues to 2001 levels.
Reference:
Nature Reviews Drug Discovery 22, 174 (2023). doi: https://doi.org/10.1038/d41573-023-00029-5
The decline of the global antibiotic market is threatening the development of new drugs
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