Antimicrobials Resistance: A Call for Multi-disciplinary Action. How Can HTA Help? A Summary of a Symposium held at HTAi Rome 2017
OHE has just published a new briefing entitled ‘Antimicrobials Resistance: A Call for Multi-disciplinary Action. How Can HTA Help?’ OHE has just published a new briefing entitled ‘Antimicrobials Resistance: A Call for Multi-disciplinary Action. How Can HTA Help?’. This publication…
Antimicrobial resistance (AMR) is in part a natural phenomenon, but its growth has been accelerated over time by different causes that now exert a cumulative effect. On the one hand, bad practice favours the spread of infections, such as overuse of antibiotics in human and veterinary care, and poor prevention and hygiene practices. On the other hand, the scarcity of new treatments, both recently launched as well as in pharmaceutical industry development pipelines, reduces the chances of treating AMR effectively in the future.
Throughout the session, the speakers provided recommendations for the strategies and actions that should be implemented in order to prevent the spread of AMR and to incentivise the development of new effective treatments.
In order to deter bad practice, stewardship and prevention programmes should promote practical actions such as:
cooperation and coordination across countries in identifying what works and in ensuring that national plans are put into place and implemented;
improved awareness and education programmes for all stakeholder groups affected by AMR (professionals and patients), to avoid preventable infections;
strong monitoring systems to keep under surveillance the infection and the colonisation rates, as well as trends in antibiotics consumption.
The Spanish experience of the Zero Tolerance programmes, implemented at hospital level and based on educational and monitoring initiatives, proved that this type of programme can be successful and impactful at reducing the colonisation and infection rates of resistant pathogens.
The development of antimicrobial drugs is subject to various challenges: the difficulty of discovering new antibiotics; lack of pre-launch data on clinical superiority, and the limited returns from investing in antibiotic R&D. Additionally, HTA methods may not reward a range of value dimensions of new antibiotics relating to their impact on public health by preventing AMR growth. HTA focuses on health gain to the treated patient. Six types of benefit that are traditionally not included in an HTA review are:
the insurance value of protection from outbreaks;
the diversity value of using alternative available antibiotics;
the value of a diagnostic to anticipate the use of an effective treatment;
the innovation value of creating a new mode of action;
the ability to preserve the safety of procedures that rely on the use of antibiotics (enablement value); and
the greater value of narrowspectrum antibiotics as compared to broad spectrum antibiotics.
A shared view is also that improvements in HTA approaches are considered more likely with collaboration between HTA bodies/ payers and with international organisations.
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