The Contingent Valuation of C Diff Antibiotics

In a presentation at the 6th International C diff Awareness Conference and Health EXPO in Philadelphia, Pennsylvania, Glenn Tillotson, PhD, discussed the development of new antibiotics and therapies for Clostridium difficile (C diff) during an era when antibiotic resistance is a serious global health threat.

In an exclusive interview with Contagion® Dr. Tillotson discussed his presentation and future avenues of treatment for C diff outside of antibiotics.

Interview transcript: (modified slightly for readability)

Contagion®: Can you summarize your presentation, “The Development and Commercialization of New C Diff Antibiotics (Pinnacles and Pitfalls of Development)?

Tillotson: Really what I was trying to do was to bring to the audience's attention that the value, or the perceived value, of our antibiotics, is actually very low unlike other drugs such as cancer drugs, rheumatology drugs and so on, where people are prepared to pay significantly more for an antibiotic. Even though we know that just 1 week of an antibiotic can extend your life by decades whereas you know these cancer and other treatments don't have that same sort of effect.

Contagion®: What do you this is the reason for this perception?

Tillotson: I think society has become complacent. We've had antibiotics for 70 years, and up until recently they've always worked, and we have up until recently paid let's say $30 for a course of antibiotics, and it's generally worked. But now that antibiotic resistance has emerged and has become under the agenda of the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC) even the PCAST (US President’s Council of Advisors of Science and Technology) — now that antibiotic resistance is more than just a threat, it's a reality, new drugs are being developed. But because it's a new era it costs more to develop an antibiotic now than it did 20 years ago. Patients and physicians are not comfortable paying $1,000 let alone $5,000 and $10,000 for a new antibiotic which is likely to save their life. So, complacency and an ‘antibiotics are disposable’ attitude; ‘there's always another [antibiotic] I can go to’ well we're running out of those options and at some stage you know someone has got to pay the piper.

Contagion®: Looking forward, what do you think are potential avenues of treatment or prevention for C diff?

Tillotson: Well I think that what will underlies C diff is an infection is a profound disturbance to the protective normal flora so usually the course of an antibiotic can do a lot of damage to that protective flora. I think the most logical thing to think of is: let's replace that flora; not perfectly to what your flora was, but at least enough to provide that layer of protection. I think restoring the microbial flora to me is a very powerful way forward, it has its problems and pitfalls several of which originate from the regulators but that's beyond this discussion.

I’m fascinated about the concept of vaccines which have been proven to work in a variety of infections, but the problem is the uptake and if you don't get enough uptake then the sort of herd immunity doesn't kick in, so it questions the validity of the vaccine.

I mean we're currently in influenza season and I think if you went out onto [main] street and asked how many people have had their flu shot, you probably be lucky to see 30 to 40%.

So, vaccines, restoration of the microbial flora, those are the 2 key ones, I know we've looked at immunoglobulins and immune status in the past, but I think that has been a little bit nonspecific. I think the specificity of a vaccine actually is better so those are my 2 other options to antibiotics.

Contagion®: Can you speak to the concept of contingent valuation that you referenced in your presentation?

Tillotson: Contingent valuation is a phrase that economists, certain insurance auditors, and those people are familiar with. The medical profession doesn't get it, and it really applies to some form of health event, and in this case an infection. We're not just looking at the impact of the infection on that 1 patient, but the impact of that event on the patient's family, workplace, and a lot of things that come together in like a giant jigsaw.

If you look at contingent valuation for things like environmental disasters, which they use to come up with the value for. [For example] Deep-Sea Horizon, the oil rig that exploded in Bay of Mexico, the evaluation had almost $19 billion dollars when they worked out all of the environmental issues and so forth. And I think it's time to assess infectious diseases in exactly the same way. So contingent valuation could help establish a more realistic pricing for antibiotics, not just go with a price that you think people might pay, but to actually look at the drugs for the impact they have on society.

If you can eradicate a patient’s pneumonia, that's a good thing because not only the cured their infection, but you've reduced the chance of that infection being spread and having a ripple effect. So, I think it's time for us to think about infectious diseases with contingent valuation and to better understand the holistic costs of an infection.

Contagion®: Can you discuss cost considerations for C diff treatment?

Tillotson: There was a recent study published I think probably 2 years ago, where they looked at all of the different components that go into managing and controlling a patient with C diff and it came to something in the order of $30,000. Now if that patient happens to fail their treatment and recur, [which is] about a 30% chance, then you want to incur those costs again. So, over a period of time, you're going from let's say of $30,000 cost to 60 to 90 and so forth, so it's difficult to take a singular C diff infection as just $30,000. It's the avoidance of the recurrence that matters. And C diff, when you compare it with other multidrug-resistant infections, is probably one of the top most expensive infections to acquire.