Key takeaways

  • Diagnostics are foundational to antimicrobial stewardship and the fight against AMR, yet their indirect and system-level impacts are not adequately captured in current reimbursement models or policy frameworks.
  • The STRIDES framework demonstrates that AMR diagnostics offer value beyond individual patient outcomes, including population and long-term health system benefits.
  • Applying STRIDES may help unlock investment and innovation in AMR diagnostics, as well as access to and utilisation of these critical technologies. By aligning economic evaluations with the true value of diagnostics, we can further strengthen the potential of AMR diagnostics in the fight against AMR.
  • STRIDES elements are synergistic, emphasising that maximum value from existing antimicrobials can only be unlocked when diagnostics and antimicrobials are used together.
  • Expert stakeholders recognise STRIDES as a necessary evolution of STEDI for use with AMR diagnostics, reflecting the need for AMR diagnostic-specific guidance to inform policy, HTA, and procurement.

Addressing a critical gap in AMR policy and evaluation

Antimicrobial resistance (AMR) is a global health crisis, projected to cause up to 10 million deaths annually and impose economic costs exceeding $150 billion by 2050. Diagnostics are essential in curbing AMR—by guiding the appropriate use of antimicrobials, informing infection control, and enabling better surveillance and treatment outcomes. Yet, despite this, diagnostics remain underutilised in both policy and practice.
One major barrier to the uptake and effective use of AMR diagnostics is the systematic undervaluation of their contributions across health systems. AMR diagnostics are not consistently or comprehensively assessed through value assessment or reimbursement frameworks, meaning their broader societal and population-level benefits are often overlooked. This under-recognition limits policy prioritisation, discourages innovation, and perpetuates structural and financial disincentives.

This report introduces STRIDES, a new conceptual value framework for AMR diagnostics that evolves and extends the established STEDI framework originally developed for antimicrobials. Importantly, STRIDES is not a replacement for existing value frameworks for healthcare interventions and diagnostics but a complementary addition—designed to capture the unique and synergistic value of diagnostics in the fight against AMR. The aim is to support a more comprehensive and systematic valuation of AMR diagnostics by decision-makers and payers across settings, ensuring that their broader benefits are recognised in decision-making and reimbursement processes. Such recognition of the potential breadth of value of AMR diagnostics is key to incentivising innovation, aiding adoption, and curbing AMR.

What STRIDES adds: a diagnostic-specific value framework

The STRIDES framework was developed to address limitations in the scope of existing health technology assessment (HTA) and reimbursement frameworks, which fail to capture the full value of diagnostics in the context of AMR. It complements the general and diagnostic-specific value elements already considered in many HTAs, such as clinical outcomes, cost offsets, and the “value of knowing”. The framework introduces seven AMR-specific value elements that are tailored to the unique role diagnostics play in preserving antibiotic effectiveness and projecting public health:

  • 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.

Each element is grounded in literature, validated by international expert consultation, and illustrated in this report through real-world examples. Together, these value elements provide a comprehensive add-on to typical approaches to HTA, to fill a critical gap in current evaluation frameworks and support a more comprehensive understanding of the value that AMR diagnostics bring to health systems and society.

Conclusions
STRIDES offers a robust, conceptual framework to capture the full value of AMR diagnostics. It provides a critical step towards appropriate value assessment of AMR diagnostics, raising awareness of the multifaceted benefits of AMR diagnostics, and how they generate value for patients, health systems, and society.

Future research should explore how STRIDES can best be operationalised, to test feasibility of implementation, and to examine how the remaining barriers to adoption of AMR diagnostics can be overcome. Continued ‘strides’ towards the adoption of AMR diagnostics are critical if we are to realise the potential of these valuable tools in the fight against AMR.

This publication, Taking STRIDES: The Value of Diagnostics Against AMR, was commissioned and funded by bioMérieux Inc.

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