Economic Opportunity and Opioid Regulation: the Case of Codeine in France,
R&R at Health Economics, TSE Working Paper N. 24-1563. (Click here to see the latest version)

Abstract: Policies restricting access to opioid medications are often powerful tools to reduce misuse, but their effectiveness may vary depending on local socioeconomic conditions. This paper shows how economic disadvantage shapes the magnitude of responses to such policies, focusing on a 2017 French regulation that banned over-the-counter (OTC) sales of Codeine-containing drugs. I first estimate the causal impact of this regulation, using a difference in differences (DiD) approach and monthly sales data for the 94 departments of Metropolitan France. I then exploit cross-department variation in the prevalence of poverty to examine heterogeneous policy responses. I find that the policy led to a significant reduction in overall Codeine consumption, but departments in economic disadvantage experienced smaller decreases in consumption. This shows that demand-side factors can amplify or hinder the effect of supply-side interventions. I further investigate substitution patterns by using data on non-opioid analgesic use, emergency department (ED) visits, and drug-related crimes. Finally, I consider potential dynamic effects and quantify the long-term policy impact. Results imply that increased barriers to access should move in parallel with additional measures addressing the most deprived local communities to ensure that regulatory efforts do not exacerbate existing health disparities.

Invisible Threat: How Airborne Pollution Fuels Antimicrobial Resistance in the EU,
TSE Working Paper N. 25-1610. (Click here to see the latest version)

Abstract: Recent scientific research suggests that the environment represents an important pathway for the spread of antimicrobial resistance (AMR). This paper is the first to provide causal estimates of the impact of fine particulate matter (PM2.5) on AMR diffusion. I focus on EU countries and the period 2002 to 2019. To pin down causal effects, I use an instrumental variable approach that exploits temperature inversions as a source of exogenous shocks to air pollution. I find that a 1% increase in PM2.5 leads to about a 0.7% increase in average antibiotic resistance, but there is significant heterogeneity across pathogen-antibiotic combinations in their responsiveness to changes in pollution. I then separately estimate the direct impact of pollution on resistance, as well as the impact of an indirect channel via antibiotic consumption. When antibiotic use is accounted for, the direct influence of air pollution on AMR remains sizable and significant. Finally, I provide a counterfactual analysis assessing the impact of alternative air pollution control policies on resistance and compare their effectiveness vis- à-vis interventions aimed at reducing antibiotic use in humans. Findings imply that pollution reduction policies can be fruitfully leveraged in the fight against AMR propagation.
Outreach: Economics of antibiotics & antibioresistance journal (TSE Health Center).

Estimating Pull Incentives for Antibiotic Development,
with Pierre Dubois and Kevin Outterson (Submitted).

Abstract: Ongoing policy efforts are designing antibiotic pull incentives that are both economically efficient and aligned with global health objectives. Estimating the appropriate size of pull incentives is important as both under- and over-sizing create risks; the first might lead to limited uptake, while the second might lead to excessive public costs. This paper estimates the pull-incentive value required for antibiotic development using the inverse of the elasticity of launched drug innovations to market revenue, which provides the necessary market revenue to achieve an innovation. The method allows for estimating heterogeneous values across pharmaceutical classes. Results suggest that antibacterial pull incentives should achieve an average of $US 4.3 billion in global life-cycle revenue. If antibacterial revenues returned to the levels achieved a quarter century ago, our shock-adjusted counterfactual predicts a substantial increase in the antibacterial pipeline, yielding approximately 3.7 additional NMEs per year.

Pull Incentives, Market Size and Pharmaceutical Innovation: From Early Preclinical Research to Drug Launch,
with Pierre Dubois. 

Marketing Intensity and Opioid Access,
with Patrick Legros. 

Abstract: The role played by pharmaceutical advertising in the healthcare sector is somewhat controversial. In this paper, we investigate theoretically and empirically how pharmaceutical companies adapt their advertising strategies in response to regulation, and how this, in turn, affects sales. We focus on the opioid analgesic market in France and study how pharmaceutical companies reallocate their advertising expenses across geographical areas following a law that forbids OTC Codeine sales. In our theoretical framework, advertising takes the form of a payment provided by a company's sale representative to healthcare professionals. Doctors recommend to their patients the most suitable treatment for their health status, trading off the risk of addiction and the pain relief benefits. Patients can either self-medicate or rely on a doctor's prescription. To empirically evaluate the impact of the new law, we exploit variation in marketing intensity across departments in the period preceding its application and compare before-after changes in advertising and sales for departments with low and high pre-treatment marketing exposure. We show that, following the new law, both marketing expenses and sales decrease, and this decrease is larger in departments initially characterized by more intensive marketing. 

The Impact of Consumption of Antibiotics on AntiMicrobial Resistance (AMR): Within and Double/debiased Machine Learning Estimates (Temporary Title),
with Pierre Dubois and Thierry Magnac.  

Pollution-Driven AMR: Causal Evidence and Policy Solutions

The proposed research project studies the causal impact of air pollution on antimicrobial resistance (AMR) and evaluates the effectiveness of clean-air policies in reducing AMR diffusion.

🏅 Awarded a Seal of Excellence (MSCA Postdoctoral Fellowships, score: 91.2%) by the European Commission.

COVID-19 and the role of inequality in French regional departments
with Victor Ginsburgh and Glenn Magerman. European Journal of Health Economics, 22: 311-327 (2021).
DOI: https://doi.org/10.1007/s10198-020-01254-0. 

Prescription Opioids and Economic Hardship in France
with Mathias Dewatripont, Victor Ginburgh, Michel Goldman, and Patrick Legros. European Journal of Health Economics (2023).
DOI: https://doi.org/10.1007/s10198-022-01557-4.
Media coverage: LeMonde, Médor (1/2), Médor (2/2), lepharmacien.be, Alternatives Economiques, ARTE tv.

Social  Science Contributions to the Global Action Plan on Antimicrobial Resistance,
Poirier, M. J. P., et al. (2026), Bulletin of the World Health Organization (click here to see the full article).