Could Contracts between Pharmaceutical Firms and French Veterinarians Bias Prescription Behaviour: A Principal-Agency Theory Approach in the Context of Oligopolies.

In France, veterinarians can both prescribe and deliver veterinary medicines, which is a questionable situation from the perspective of antimicrobial use (AMU) reduction to avoid antimicrobial resistance (AMR). This situation places veterinarians in direct commercial relationships with the pharmaceutical industry as purchase contracts are signed between veterinarians and pharmaceutical companies. The aim of the present work is to analyse the relationships between veterinarians and pharmaceutical firms in the oligopoly market context of French veterinary medicine to determine whether the prescription behaviour of practitioners can be biased by joint prescription and delivery. Therefore, we develop an analysis based on principal-agent theory. Contracts between pharmaceutical companies and veterinarians during the 2008-2014 period were analysed based on 382 contracts related to 47 drugs belonging to eight main pharmaceutical firms (2320 observations). The price per unit after rebate of each drug and contract was calculated. The descriptive analysis demonstrated high disparity among the contracts across pharmaceutical firms with regard to the provisions of the contracts and how they are presented. Then, linear regression was used to explain the price per unit after rebate based on the explanatory variables, which included the yearly purchase objective, year, type of drug and type of rebate. The decrease in price per unit after rebate for each extra €1000 purchase objective per drug category was established to be €0.061 per 100 kg body weight for anticoccidiosis treatments, €0.029 per 100 kg body weight for anti-inflammatories, €0.0125 per 100 kg body weight and €0.0845 per animal for antiparasitics, and €0.031 per animal for intramammary antimicrobials. Applying agency theory reveals that veterinarians can be considered agents in the case of monopolistic situations involving pharmaceutical firms; otherwise, veterinarians are considered principals (oligopolistic situations in which at least several medicines have similar indications). The present study does not provide evidence suggesting that joint prescription and delivery may introduce any potential prescription bias linked to conflicts of interest under the market conditions during the 2008-2014 period.

The economics of antimicrobial resistance in veterinary medicine: Optimizing societal benefits through mesoeconomic approaches from public and private perspectives.

Antimicrobial resistance (AMR) is a global public health threat driven by a combination of factors, including antimicrobial use (AMU) and interactions among microorganisms, people, animals and the environment. The emergence and spread of AMR in veterinary medicine (AMR-V) arising from AMU in veterinary medicine (AMU-V) can be linked to individuals' economic behaviour and institutional context. We highlight the limitations of current microeconomic approaches and propose a mesoeconomic conceptual model of AMR-V that integrates actors' strategic and routine behaviours in their context from a dynamic perspective using the concepts of externality, globality and futurity. The global solution to AMR-V management relies on a trade-off between i) the global externality assessment of AMU-V with respect to AMR-V (public perspective) and ii) farm- or value chain-level marginal abatement cost evaluation (private perspective). The improvements realized by the proposed mesoeconomic conceptual model include i) the simultaneous fight against the emergence and spread of AMR-V and ii) a local decrease in AMU-V without any loss of competitiveness for private actors due to the development of adequate production standards. A set of generic equations describing the stepwise change in the scale of analysis is finally proposed. This original contribution to the global challenge of AMR through a mesoeconomic approach bring substantial improvement for better AMU. This model can be considered a way to smoothly promote institutional change and a call for public policies that support public private partnership in the development of adequate incentives. The model requires further development prior to its application in a given value-chain or territory.

Defining health standards through economic optimisation: The example of colostrum management in beef and dairy production.

There is extensive literature addressing acceptable practices of colostrum distribution to new-born calves; however, no economic analyses are available concerning the profitability of this practice. Moreover, the health standards associated with colostrum management have been defined through the observation of reference farms without explicit reference to economic assessments. The objective of the current study was to evaluate the profitability of farm colostrum management and to define the optimal economic situations for given livestock systems and farm situations. The herd-level net value was calculated using the value of calf products, the cost of passive transfer failure and the cost of prevention. This value was determined for various beef and dairy scenarios and the various time periods spent managing colostrum. The maximal net values defined the optimal economic situations and enabled the determination of the optimal times for colostrum management and respective health standards (i.e., the prevalence of disorders at optimum). The results showed that the optimal time farmers should spend on colostrum management is approximately 15 min per calf. Furthermore, farmers should err on the side of spending too much time (> 15 min) on colostrum management rather than not enough, unless the cost of labour is high. This is all the more true that potential long term consequences of passive transfer failure on milk yields were not accounted for here due to scarcity of data, leading to consider this time threshold (15 min) as a minimal recommendation. This potential underestimation may arise from the greater nutrient content and bioactive compounds identified in colostrum although the passive immune transfer is here defined through immunoglobulins only. The present results show that for small farms that cannot hire colostrum managers, this work can be performed by the farmer after subcontracting other tasks. Moreover, the method proposed here-the definition of health standards through economic optimisation-is a promising approach to analysing health conventions in the cattle industry.

Herd-level and territorial-level factors influencing average herd somatic cell count in France in 2005 and 2006.

Mastitis is a multifactorial disease and the most costly dairy production issue. In spite of extensive literature on udder-health risk factors, effects of metabolic diseases, farmers' competencies and livestock farming system on somatic cells count (SCC) are sparsely described. Herd-level or territorial-level factors affecting monthly composite milk weighted mean cow SCC (CMSCC) were analysed with a linear mixed effect model. The average CMSCC was 266,000 cells/ml. Half of the herds had CMSCC >300,000 cells/ml for 2-6 months a year, and 15% of herds for more than 7 months a year. CMSCC was positively associated with the number of cows, having a beef or fattening herd in addition to the dairy herd, the monthly average days in milk, the yearly age at first calving, the yearly proportion of purchased cows and the yearly culling rate. Moreover, a positive association is reported between CMSCC and the monthly proportion of cows probably with subacute ruminal acidosis (fat percentage minus protein percentage ≤0·30%, for Holstein) and negative energy balance (protein to fat ratio ≤0·66, for Holstein), the yearly average calving interval, having at least one dead cow and the mean monthly temperature. The association was negative for a predominant breed other than Holstein, the monthly milk production, the yearly dry-off period length, the monthly first calving cow proportion, having an autumn calving peak, being a Good Breeding Practices member, the monthly number of days with rain, the altitude and the territorial cattle density. CMSCC varied widely among the 11 dairy production areas. In conclusion, this study showed the average CMSCC for the French dairy cows, compared with international results. Moreover, it quantified the contribution of several factors to CMSCC, in particular metabolic diseases and the farm environment.