Challenges for Economic Evaluation of Health Care Strategies to Contain Antimicrobial Resistance
2.1. Capturing the Benefits of Strategies to Contain Antimicrobial Resistance
Measure of Health Outcome
2.3. Capturing the Long-Term Costs of Antimicrobial Resistance
2.4. Time Preference
Conflicts of Interest
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|Item||Example of Challenges||Recommendations|
|Population||Population extends beyond those receiving the intervention. This is also likely to extend across health technology agency (HTA) boundaries.||Where appropriate, extend the population beyond the cohort receiving the intervention and consider other/future patients who become infected by a resistant pathogen, or who have not experienced resistant infection but receive alternative agents due to increased resistance of common pathogens.|
|Clinical||Adequate measurement of the expected rate of growth of antimicrobial resistance and associated outcomes over time. Clinical parameters in the present are more easily captured than those associated with future global consequences.||Use both empirical data and secondary data to forecast long-term clinical consequences. Ensure appropriate assessment of uncertainty.|
|Costs||Resource implications most likely to be short-term. Difficult to capture long-term resource use and the cost of negative externalities. Cost of health care intervention impacts different budgets to the return, e.g., primary care cost in short-term, for long-term secondary care gains.||Application of robust resource use data collection methods . Include costs of treating patients not receiving the intervention (see population). Use threshold analysis as an alternative to specifying attaching an actual cost to antimicrobial resistance.|
|Health outcomes||Health states associated with acute infection may be perceived as transient, which limits the validity of trade-off exercises typically used for utility valuation. Utility measures, such as the EQ-5D, measure health “today” and fail to capture the value (utility) associated with future health gains.||Cautious interpretation of quality-adjusted-life year (QALY) gains. Consider alternative or multiple frameworks for analysis, e.g., disability-adjusted-life year (DALYs) to assess global burden, cost-benefit analysis, using contingent valuation.Where appropriate include the disutility for patients with resistant infection and the disutility of alternative agents.|
|Perspective||Economic evaluations of health care intervention are often restricted to direct health effects and costs with the health technology program considering the evidence. Antimicrobial resistance is a societal issue and extends beyond individual HTA jurisdictions.||Consider a societal perspective to reflect the true range of costs and outcomes. Acknowledge the limitations of HTA by individual agencies.|
|Time horizon||Evaluations often adopt inadequate time horizons. Time preference may be paradoxical for antimicrobial consumption. Costs and outcomes extend to future generations.||Adopt a lifetime horizon of analysis, use appropriate discounting rates, and conduct empirical research on time preferences for antimicrobial preferences.|
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Holmes, E.A.F.; Hughes, D.A. Challenges for Economic Evaluation of Health Care Strategies to Contain Antimicrobial Resistance. Antibiotics 2019, 8, 166. https://doi.org/10.3390/antibiotics8040166
Holmes EAF, Hughes DA. Challenges for Economic Evaluation of Health Care Strategies to Contain Antimicrobial Resistance. Antibiotics. 2019; 8(4):166. https://doi.org/10.3390/antibiotics8040166Chicago/Turabian Style
Holmes, Emily A. F., and Dyfrig A. Hughes. 2019. "Challenges for Economic Evaluation of Health Care Strategies to Contain Antimicrobial Resistance" Antibiotics 8, no. 4: 166. https://doi.org/10.3390/antibiotics8040166