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Essays on antibiotic prescription and pharmaceutical regulation

Stamboglis, N. (2020). Essays on antibiotic prescription and pharmaceutical regulation. (Unpublished Doctoral thesis, City, University of London)


Recent years saw a sharp increase in antibiotic resistance world-wide. The increase in resistance poses a serious threat to society and health systems. Over-prescription of antibiotics in primary care represents one of the key reasons for the surge in resistance. This thesis analyses the effectiveness of EU-wide policies in reducing over-prescription. This work then explores spatial dependence in antibiotic prescription in England. Lastly, this thesis analyses the impact of pharmaceutical regulation on social welfare and innovation. Understanding the impact of pharmaceutical regulation on innovation is important in addressing antibiotic resistance as one of the reasons behind the surge in resistance consists of a lack of newly developed antibiotics.

Chapter 2 studies the effectiveness of stewardship programmes in reducing antibiotics consumption across European countries.Using data from the Euro barometers 72.5 (Nov-Dec 2009), 79.4 (April 2013), 85.1 (April 2016), and 90.1 (September 2018), I estimate the impact of stewardship programmes on antibiotic consumption via difference-in-difference analysis,run on a representative sample of the European population. I identify a negative impact of stewardship programmes on antibiotic consumption by means of diff-in-diff analysis. The effect is significant across years, as well as for individual years of policy implementation. I identify inter-temporal effects of the policy, with significant lead effects following its introduction. The results on stewardship are confirmed, even when accounting for alternative national policies,such as National Action Plans (NAP). Stewardship programmes present an impact also on alternative dependent variables, such as receiving antibiotics from a doctor, patient’s intention to consult a doctor for future use, as well as patients opinions on antibiotics.

Chapter 3 explores spatial dependence in antibiotic prescription across English GP practices,by means of a spatial panel analysis developed from presentation level data for the years 2013-2017. I link antibiotic prescription rates to the local characteristics of GP practices, considering demographics, quality of care, condition prevalence, access to services, and supply-side variables. I estimate the role of spatial dependence via SLX models. I test two alternative measures of distance across practices: institutional and geographical proximity. I explore different channels of spatial dependence by means of interaction effects, spatial error and spatial auto regressive models.This paper finds that local demographics, supply side factors, condition prevalence and proxies of access to services all influence antibiotic prescription. Lastly, this paper identifies evidence of spatial dependence in prescription rates for all antibiotics as well as for individual antibiotic classes across English GP practices.

Chapter 4 analyses the impact of price regulation and patent length in influencing social welfare in a dynamic pharmaceutical market with innovation. After introducing a dynamic two-period model with R & D, I explore the trade-off between static efficiency, in which the regulator optimizes for surplus in individual periods, and dynamic efficiency, in which the regulator optimizes welfare in both periods, accounting for the firm’s investment decisions. I then explore the impact of Value-Based Pricing (VBP) regulation, by which the regulator sets prices proportional to expected health benefits. I find an inter-temporal trade-off between static and dynamic welfare. I study the price vs patent trade-off which the regulator might exploit to obtain desired policy results. I compare welfare in an alternative market where the firm is allowed to maximise profits, studying the impact on the amount of market innovation. Lastly, I identify that VBP policy influences consumer surplus and innovation decisions.

Publication Type: Thesis (Doctoral)
Subjects: H Social Sciences > HB Economic Theory
Departments: Doctoral Theses
School of Policy & Global Affairs > Economics
School of Policy & Global Affairs > School of Policy & Global Affairs Doctoral Theses
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