Fight against AMR: the role of diagnostics and the impact of air pollution

Antibiotics once stood as a beacon of hope, a panacea against a multitude of bacterial infections. They have revolutionized healthcare, extended lifespans and reduced the suffering caused by once-deadly diseases. However, these weapons are losing their edge as indiscriminate use of antibiotics accelerates the emergence of drug-resistant superbugs. The World Health Organization now describes antimicrobial resistance (AMR) as one of the biggest threats to global health, food security, and development. If left unchecked, estimates suggest it could cause up to 10 million deaths per year by 2050. Governments must act fast, but joined-up thinking and judicious use of limited resources will also be essential.

To face this AMR challenge, TSE economists are committed to providing informed solutions and rigorous evaluation of the effectiveness of public policies. In a new edition of our Economics of antibiotics & antibioresistance journal, we highlight some of the latest investigations conducted by our researchers,

This new issue features the recent work of David Bardey, Philippe De Donder, and Vera Zaporozhets on the role of diagnostic tests in the effective management of antibiotics and also highlights Ilaria Natali’s research on the correlation between air pollution and the spread of AMR.

Key policy insights

Unlocking the power of diagnostic tests

Doctors are influenced in part by monetary incentives. FFS schemes tend to inflate healthcare costs, while CAP payments and salaries may contain them at the expense of quality.
Non-financial motivations matter too. For instance, doctors prescribe fewer tests when aware of their patients’ out-of-pockets costs.
Well-known and easily interpreted tests are used more often. However, investing time and effort in learning to use tests may encourage doctors to use them more.
Diagnostic tests should not always be made mandatory, even when costless, or reimbursed separately from the relevant treatment.
Companion tests increase the likelihood that a treatment will be approved. Tests are less likely to be developed after approval because they lack this incentive and reduce market size.
P4P schemes, procurement design and price regulation can be used to encourage development of companion tests. Incentives are higher if labs compete or if the treatment is not very effective.
Tests may raise prices by dampening price competition. However, they may also improve the efficacy of cheaper drugs.

Air pollution and antimicrobial resistance

This research provides the first causal evidence that air pollution is increasing AMR rates in the EU.
The role of air pollution in driving AMR is almost as important as antibiotic use.
Anti-pollution measures – in particular, adhering to WHO air quality standards – can dramatically reduce the spread of AMR.
If cost-benefit analyses ignore the causal impact of pollution on AMR, policymakers will undervalue the benefits of cleaner air.
Existing estimates on the costs of air pollution are likely to be a lower bound.

Want to read more?

Economics of antibiotics & antibioresistance journal

This work was carried out with the support of the partners of the TSE Health Center, in particular bioMérieux, as well as Bpifrance through the ARPEGE consortium.

Published in TSE Reflect, May 2025

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