Global pricing of AWaRe (Access, Watch, Reserve) antibiotics: implications of the UNGA-AMR 70% Access target on national pharmaceutical expenditure

Abstract Background The United Nations General Assembly High-level Meeting on Antimicrobial Resistance (UNGA HLM-AMR) committed to a target that 70% of global human antibiotic use (ABU) should be from the Access group of the WHO AWaRe system. Methods We used 2019 IQVIA MIDAS® global ABU Quarterly value sales, volumes (kg/SU) and average ex-manufacturer prices to evaluate price per daily defined dose (DDD) by AWaRe group across countries. IQVIA MIDAS volumes/value data reflect public, private, or mixed sectors. We estimated potential national pharmaceutical expenditure savings if i) the UNGA 70% Access target was met, and ii) national ABU aligned with the WHO Model List of Essential Medicines (EML). We evaluated 7-day treatment prices for common oral and parenteral antibiotics across AWaRe groups. We measured affordability in middle-income countries (MICs) by income group, as the percentage of the population at risk of falling below national poverty lines if paying out-of-pocket, using income distributions and generalised beta distributions of the second kind. Prices were reported in 2019 international dollars (I$). Results Volume-weighted ex-manufacturer prices per DDD were lower for Access (I$1·2, IQR I$0·7) than Watch (I$2·6, IQR I$2·1) and highest (I$83·8, IQR I$80·9) for Reserve antibiotics. Lower prices were seen in high-income countries for Access antibiotics. Meeting the 70% Access target could save countries I$0·1 million–I$4·9 billion annually. Global savings could reach I$10·4 billion if only WHO EML-listed antibiotics were used. Seven-day parenteral meropenem could put 7% (IQR 9%) of the population in MICs at risk of impoverishment. Conclusion Antibiotic policies focused on achieving the UNGA-AMR 70% Access target could generate significant potential national and global expenditure savings. Funding This work was supported by the Wellcome Trust (304681/Z/23/Z) as part of the Antibiotic Data to Inform Local Action (ADILA) project and the Global Antibiotic Policy initiative (GAPi) project (RES 2024-495).