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Value assessment of antimicrobials and the implications for development, access, and funding of effective treatments: Australian stakeholder perspective

Part of: Special Collection - Methods

Published online by Cambridge University Press:  03 November 2020

Nadine T. Hillock Open the ORCID record for Nadine T. Hillock [Opens in a new window] ,
Tracy L. Merlin ,
Jonathan Karnon ,
John Turnidge  and
Jaklin Eliott
Nadine T. Hillock*
Affiliation:
School of Public Health, University of Adelaide, Adelaide, SA5000, Australia
Tracy L. Merlin
Affiliation:
School of Public Health, University of Adelaide, Adelaide, SA5000, Australia
Jonathan Karnon
Affiliation:
College of Medicine and Public Health, Flinders University, Bedford Park, SA5042, Australia
John Turnidge
Affiliation:
School of Medical Sciences, University of Adelaide, Adelaide, SA5000, Australia
Jaklin Eliott
Affiliation:
School of Public Health, University of Adelaide, Adelaide, SA5000, Australia
*
Author for correspondence: Nadine T. Hillock, E-mail: nadine.hillock@adelaide.edu.au
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Abstract

Background

The frameworks used by Health Technology Assessment (HTA) agencies for value assessment of medicines aim to optimize healthcare resource allocation. However, they may not be effective at capturing the value of antimicrobial drugs.

Objectives

To analyze stakeholder perceptions regarding how antimicrobials are assessed for value for reimbursement purposes and how the Australian HTA framework accommodates the unique attributes of antimicrobials in cost-effectiveness evaluation.

Methods

Eighteen individuals representing the pharmaceutical industry or policy-makers were interviewed. Interviews were transcribed verbatim, coded, and thematically analyzed.

Results

Key emergent themes were that reimbursement decision-making should consider the antibiotic spectrum when assessing value, risk of shortages, the impact of procurement processes on low-priced comparators, and the need for methodological transparency when antimicrobials are incorporated into the economic evaluation of other treatments.

Conclusions

Participants agreed that the current HTA framework for antimicrobial value assessment is inadequate to properly inform funding decisions, as the contemporary definition of cost-effectiveness fails to explicitly incorporate the risk of future resistance. Policy-makers were uncertain about how to incorporate future resistance into economic evaluations without a systematic method to capture costs avoided due to good stewardship. Lacking financial reward for the benefits of narrower-spectrum antimicrobials, companies will likely focus on developing broad-spectrum agents with wider potential use. The perceived risks of shortages have influenced the funding of generic antimicrobials in Australia, with policy-makers suggesting a willingness to pay more for assured supply. Although antibiotics often underpin the effectiveness of other medicines, it is unclear how this is incorporated into economic models.

Keywords

Value assessmentResource allocationInnovationCost-effectivenessAntimicrobials
Type
Method
Information
International Journal of Technology Assessment in Health Care , Volume 37 , Issue 1 , 2021 , e28
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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