Antimicrobial resistance (AMR) is an urgent global health crisis. AMR infections cause an estimated 1.3 million deaths globally every year, and this number is only projected to rise.
Overview
Antimicrobial resistance (AMR) is an urgent global health crisis. AMR infections cause an estimated 1.3 million deaths globally every year, and this number is only projected to rise. The Global Research on Antimicrobial Resistance (GRAM) Project has predicted that in the next 25 years, AMR will cause 39 million deaths – that’s three deaths every minute.
In addition to the staggering human cost of AMR, it also has economic implications that can’t be ignored: the World Bank estimates that AMR could result in $1 trillion additional healthcare costs by 2050, and upto $3.4 trillion in GDP losses in the next 5 years alone.
Combatting AMR isn’t just a public health imperative – it’s essential to safeguard healthcare systems and economies worldwide. To this end, key priorities include prevention and infectious disease management, increasing uptake and access to treatment and diagnoses and overall improved antimicrobial stewardship. The evolving understanding of value in AMR diagnostics is a critical part of this stewardship, and is the topic of one of OHE’s most recent publications on AMR.
What is antimicrobial stewardship?
Antimicrobial stewardship (AMS) refers to a coordinated, system-wide approach to promoting and monitoring the optimal use of antibiotics.
The role of diagnostics in curbing AMR
Diagnostics are critical in the fight against AMR, by guiding the appropriate use of antimicrobials, informing infection control, and enabling better stewardship, surveillance and treatment outcomes. However, despite their proven benefits, diagnostics remain underutilised and understudied, in both policy and practice.
While AMR diagnostics offer benefits to individual patients through accurate diagnosis and treatment, current assessment approaches fail to evaluate their population-level impact in terms of reducing AMR. This under-recognition hinders effective policy making, discourages innovation and perpetuates structural and financial disincentives.
In our latest report on AMR diagnostics, we identify key barriers to uptake and roll-out:
- Limited training, time, and resources in healthcare settings
In primary care settings, where the majority of antibiotics are prescribed, healthcare professionals who are often operating under major time constraints, may find prescribing antimicrobials quicker and cheaper (in the short run) than ordering a diagnostic test.
There is evidence that limited training and education on the utility of diagnostics exacerbates this issue; healthcare professionals have cited that improvements to guidelines around diagnostic use and greater educational campaigns for clinicians would aid the implementation of AMR diagnostics.
- Misaligned incentives for payers and stakeholders
While costs are incurred by one sector (usually primary care) the benefits, like reduced hospitalisations, only accrue elsewhere (i.e primary care doesn’t benefit; secondary care would). These silos also exist in hospitals: the costs are incurred by laboratory departments, while the benefits are realised on the wards and at the overall hospital level. This misalignment of incentives hinders a comprehensive approach towards diagnostic tests.
Moreover, diagnostics are often paid for through Diagnosis Related Groups for inpatient care, where clinicians are incentivised to minimise costs and therefore not utilise diagnostics.
- Low reimbursement
AMR diagnostics have broader macroeconomic and population-wide benefits beyond individual patient outcomes – but this value is not captured in HTA value assessments. There is therefore a disconnect between the level of reimbursement and the value diagnostics provide in terms of health benefits and cost savings, which may discourage innovation in the diagnostic space.
- Lack of policy prioritisation
Unlike antimicrobials, diagnostics are frequently omitted from AMR action plans, receiving less recognition from policymakers, compared to other interventions aimed at reducing antimicrobial use. Existing evidence gaps on the value of AMR diagnostics only compounds this issue.
Valuing AMR Diagnostics—from STEDI to STRIDES
To address these issues, a fuller understanding of the value of AMR diagnostics is needed.
OHE research was key in informing the development of the STEDI value framework, which encapsulated the broader value generated by antimicrobials. STEDI referred to elements of value potentially generated by antimicrobials – Spectrum, Transmission, Enablement, Diversity, and Insurance value.
The STEDI-framework ultimately formed the basis of the NICE-NHS England subscription model for evaluating and purchasing antimicrobials in the UK.
The STEDI framework cannot be directly applied to AMR diagnostics because diagnostics have distinct value pathways from antimicrobials – the impact of diagnostics is indirect, shaping clinical decisions rather than exerting a direct therapeutic effect like antimicrobials. A new value framework, that builds on STEDI but is specific to AMR diagnostics, is necessary to appropriately capture their contribution.
STRIDES: A diagnostic-specific value framework
In our most recent report, we introduce seven value elements designed to highlight the broader value of AMR diagnostics in reducing AMR:
- Spectrum value: Enables use of narrow-spectrum antibiotics by identifying specific pathogens and resistance patterns.
- Transmission value: Reduces the spread of infectious and resistant pathogens through earlier detection and control.
- Research value: Supports the development of new antimicrobials by improving trial recruitment and design.
- Insurance value: Helps preserve last-line antimicrobials and mitigate catastrophic AMR outbreaks.
- Diversity value: Facilitates more varied and targeted antimicrobial use, reducing resistance selection pressure.
- Enablement value: Allows safe continuation of high-risk medical procedures by ruling in/out infections.
- Surveillance value: Enables real-time, accurate monitoring of resistance trends.
Final thoughts
Just as STEDI proposed an extension of traditional value assessments of antimicrobials in HTA, our most recent report proposes a STRIDES framework, which is intended to complement and extend how the value of AMR diagnostics is understood.
The STRIDES framework fills a critical gap in current policy evaluation frameworks, supporting a more comprehensive understanding of the value that AMR diagnostics bring to health systems and society.