Antimicrobial Resistance: Is Health Technology Assessment Part of the Solution or Part of the Problem?

Abstract

Antimicrobial resistance is a serious challenge to the success and sustainability of our healthcare systems. There has been increasing policy attention given to antimicrobial resistance in the last few years, and increased amounts of funding have been channeled into funding for research and development of antimicrobial agents. Nevertheless, manufacturers doubt whether there will be a market for new antimicrobial technologies sufficient to enable them to recoup their investment. Health technology assessment (HTA) has a critical role in creating confidence that if valuable technologies can be developed they will be reimbursed at a level that captures their true value. We identify 3 deficiencies of current HTA processes for appraising antimicrobial agents: a methods-centric approach rather than problem-centric approach for dealing with new challenges, a lack of tools for thinking about changing patterns of infection, and the absence of an approach to epidemiological risks. We argue that, to play their role more effectively, HTA agencies need to broaden their methodological tool kit, design and communicate their analysis to a wider set of users, and incorporate long-term policy goals, such as containing resistance, as part of their evaluation criteria alongside immediate health gains.

Problems of assessing economic effectiveness of antimicrobial agents: an experience of the Russian Federation

“…Кроме того, большинство моделей инфекционных за болеваний рассчитаны на популяционный уровень, что значимо отличает их от моделей, используемых при изу чении экономической эффективности ЛС, применяемых при неинфекционной патологии. Так, модели инфекци онных заболеваний обычно имеют больше параметров, поскольку они включают риски распространения инфек ции между отдельными лицами в дополнение к прогрес сированию заболевания у конкретного пациента [30].…”

The economic challenges of new drug development

“…However, progress remains slow. A critical question that needs to be addressed is how a reasonable fixed price can be determined [ 15 ]. While the price must incentivize innovation, it must also, in a single-payer healthcare system, be good value to the taxpayer [ 15 ].…”

“…A critical question that needs to be addressed is how a reasonable fixed price can be determined [ 15 ]. While the price must incentivize innovation, it must also, in a single-payer healthcare system, be good value to the taxpayer [ 15 ]. While this value should undoubtedly account in some way for the wider costs of antibiotic resistance, estimating such a value is immensely challenging; it may be more pragmatic to adopt an insurance-based valuation approach, where the new antibiotic is seen as contributing to insuring against the societal costs from a substantial reduction in the effectiveness of current antibiotics [ 6 ].…”

Development and use of an ESBL coding gene panel in patients undergoing first-line eradication therapy for Helicobacter pylori

“…Appropriate and inappropriate use of antimicrobials is a well-established driver of resistance (Arcilla et al, 2017;El Salabi et al, 2013;Oo et al, 2022) because it can facilitate the selection of resistant bacteria (Mulder et al, 2021;von Wintersdorff et al, 2016) by opening an ecological niche where resistant pathogens can ourish (Colson et al, 2021). Several steps have been suggested to slow down the emergence of resistance and preserve antimicrobial e ciency.…”

“…Several steps have been suggested to slow down the emergence of resistance and preserve antimicrobial e ciency. These included controlled usage of antibiotic agents in farming, development of strategies to prevent illnesses, improved antibiotic usage strategies, development of novel antimicrobial agents, and others (Alghamdi, 2021;Colson et al, 2021). Therefore, new technologies and improved diagnostics are required to tackle at least some of the aforementioned issues and ensure that antimicrobial agents are only used when necessary.…”