Antibacterial drugs account for between 6 and 21% of the drug market in various countries, or between 3 and 25% of the total prescriptions. Given the high usage of these agents, they are appropriate candidates for economic appraisal in the near future.
It is probable that the marketplace and healthcare reform will give managed care the dominant position in the US healthcare system. Cost-effectiveness analyses of managed care organisations are based on both hospital and outpatient costs, and they are increasingly being aimed at formulary decisions regarding pharmaceuticals. Appropriate outcome parameters, long term follow-up, and phase IV trials to determine costs and outcomes relating to actual clinical use are needed to assess cost-effectiveness. Unbiased pharmacoeconomic research is needed to accurately answer questions on the economic viability of new products, and to avoid scepticism on the part of the purchasers of healthcare. The ultimate challenge for research and development of new antibiotics will be to reconcile the needs of the patient with the economic needs of society, within the cost-effectiveness paradigm.