20 July 2023
A new study by LCP Health Analytics, together with a commentary published in Frontiers Public Health, emphasises the importance of capturing the full value of new antimicrobials to healthcare systems and society. This could help align incentives for the development and innovation required to tackle the slow pandemic of Anti-Microbial Resistance (AMR) deaths which is associated with more than 4 million deaths in 2019, a figure projected to rise to 10 million per year globally if no action is taken.
Beyond alleviating illness, the value of prevention and preparedness in healthcare interventions often extends to mitigating disease transmission, safeguarding the wider population and enabling social and economic activities. Recognising and quantifying the full value of key preventative interventions, such as vaccines, antimicrobials and antivirals, is crucial to align incentives for investment in patient and population health. This study quantifies the wider societal benefit – productivity and informal care – along with insurance value, defined by the National Institute for Health and Care Excellence (NICE) as having antimicrobials available for a sudden increase of infections with pathogens resistant to existing antimicrobials.
The COVID-19 pandemic revealed the immense value of interventions that prevent illness and maintain good health to the wider economy as well as to healthcare systems. Beyond treating an illness, these interventions can play a vital role in stopping disease spread, safeguarding the vulnerable and allowing the economy to stay open. However, traditional approaches to health technology assessment often fail to capture their true value to society and the economy.
To date, wider societal benefits have not been regularly captured in the assessment of new medicines, however this study demonstrates that societal benefits and societal insurance value is a critical component of assessing the value of novel antimicrobials and other interventions. It quantifies the worth of having a treatment available in the case of major or rapidly escalating health problems. Insurance value of a health intervention captures the overall cost savings to a healthcare system from preventing or mitigating impacts of adverse health events. In the context of antimicrobials, this is especially pertinent considering the potential disruptions caused by a catastrophic increase in AMR to conventional antimicrobials.
The study, funded by Pfizer Ltd, estimated the insurance value to the healthcare system and wider societal benefits – namely productivity and informal care – of four scenarios where effective antimicrobials are crucial:
- A number of hospital wards closing down due to an outbreak of infections.
- Unavoidable shortage of conventional antimicrobials, mandating urgent use of the novel antimicrobial as a replacement antimicrobial.
- A viral respiratory pandemic resulting in affected patients experiencing relevant secondary bacterial infections.
- A catastrophic AMR scenario, characterised by a large increase in AMR levels and microbial infection rates.
The team’s analysis estimated a mean insurance value of a novel antimicrobial across all four scenarios to be £718 million in the UK over a 10-year period, should AMR levels remain unchanged (a conservative projection), with £134 million attributed to operational healthcare cost savings and £584 million attributed to wider health, productivity and informal care cost savings. This insurance value ranged from £27 million for the ward closure scenario to close to £300 million each for the viral respiratory pandemic and catastrophic AMR scenarios, and would be 50%-70% higher if AMR steadily increased or if a more risk-averse view of future events is taken.
Given the urgent need to address AMR, the authors of the study propose focused action in two areas:
- Future research should aim to quantify insurance value and broader value elements specific to therapeutic areas with need for further innovation, whilst understanding how this value evolves over time and across population groups.
- Stakeholders involved in the assessment of new therapeutics, such as NICE in England, should move beyond traditional HTA assessment approaches to include more holistic evaluations that better reflect the value of medicines to patients, society and the economy.
Dr Mei Chan, LCP Health Analytics Senior Statistician and co-author of the study said on the need for valuing health holistically: “The Covid-19 pandemic underscored the broad impacts health has on society. Valuing health holistically and investing in innovation and health system resilience will be key to addressing future major health challenges. Collaborative efforts amongst regulators, academia, and industry are needed to incorporate holistic value assessments into medicines and re-energise investment into diseases with high unmet need.”
Dr Jonny Pearson-Stuttard, Head of LCP Health Analytics and senior author of the study said on the societal insurance value of AMR specifically: “Traditional payment mechanisms for medicines have not incentivised investment in antimicrobials, with few new classes of antibiotics developed since the 80s. Our research into societal insurance value underlines the importance of new and holistic approaches to value assessment for antimicrobials not just from a human health perspective, but economic and societal perspectives too. Capturing the wider societal perspective will be crucial to reflect the true value of medicines and align incentives between patients, healthcare systems and the research and development ecosystem.”