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Baltas I, Gilchrist M, Koutoumanou E, Gibani MM, Meiring JE, Otu A, Hettle D, Thompson A, Price JR, Crepet A, Atomode A, Crocker-Buque T, Spinos D, Guyver H, Tausan M, Somasunderam D, Thoburn M, Chan C, Umpleby H, Sharp B, Chivers C, Vaghela DS, Shah RJ, Foster J, Hume A, Smith C, Asif A, Mermerelis D, Reza MA, Haigh DA, Lamb T, Karatzia L, Bramley A, Kadam N, Kavallieros K, Garcia-Arias V, Democratis J, Waddington CS, Moore LSP, Aiken AM. Exploring the views of infection consultants in England on a novel delinked funding model for antimicrobials: the SMASH study. JAC Antimicrob Resist 2023; 5:dlad091. [PMID: 37533762 PMCID: PMC10391702 DOI: 10.1093/jacamr/dlad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/10/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives A novel 'subscription-type' funding model was launched in England in July 2022 for ceftazidime/avibactam and cefiderocol. We explored the views of infection consultants on important aspects of the delinked antimicrobial funding model. Methods An online survey was sent to all infection consultants in NHS acute hospitals in England. Results The response rate was 31.2% (235/753). Most consultants agreed the model is a welcome development (69.8%, 164/235), will improve treatment of drug-resistant infections (68.5%, 161/235) and will stimulate research and development of new antimicrobials (57.9%, 136/235). Consultants disagreed that the model would lead to reduced carbapenem use and reported increased use of cefiderocol post-implementation. The presence of an antimicrobial pharmacy team, requirement for preauthorization by infection specialists, antimicrobial stewardship ward rounds and education of infection specialists were considered the most effective antimicrobial stewardship interventions. Under the new model, 42.1% (99/235) of consultants would use these antimicrobials empirically, if risk factors for antimicrobial resistance were present (previous infection, colonization, treatment failure with carbapenems, ward outbreak, recent admission to a high-prevalence setting).Significantly higher insurance and diversity values were given to model antimicrobials compared with established treatments for carbapenem-resistant infections, while meropenem recorded the highest enablement value. Use of both 'subscription-type' model drugs for a wide range of infection sites was reported. Respondents prioritized ceftazidime/avibactam for infections by bacteria producing OXA-48 and KPC and cefiderocol for those producing MBLs and infections with Stenotrophomonas maltophilia, Acinetobacter spp. and Burkholderia cepacia. Conclusions The 'subscription-type' model was viewed favourably by infection consultants in England.
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Affiliation(s)
| | - Mark Gilchrist
- Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Eirini Koutoumanou
- Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Malick M Gibani
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - James E Meiring
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Akaninyene Otu
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Hettle
- Department of Infection Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Ameeka Thompson
- Department of Infection Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - James R Price
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Anna Crepet
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Dimitrios Spinos
- Department of ENT, Head and Neck Surgery, Gloucester Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Hudson Guyver
- James Paget University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Matija Tausan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Maxwell Thoburn
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Cathleen Chan
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Umpleby
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Bethany Sharp
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Callum Chivers
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Ronak J Shah
- Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan Foster
- Directorate of Pharmacy, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Amy Hume
- Directorate of Pharmacy, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Christopher Smith
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Ammara Asif
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | | | - Thomas Lamb
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People’s Democratic Republic
| | | | | | - Nikhil Kadam
- Mid and South Essex NHS Trust, Westcliff-on-Sea, UK
| | | | | | - Jane Democratis
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | | | - Luke S P Moore
- Imperial College Healthcare NHS Trust, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, NIHR Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, London, UK
| | - Alexander M Aiken
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Value assessment of antimicrobials and the implications for development, access, and funding of effective treatments: Australian stakeholder perspective. Int J Technol Assess Health Care 2021; 37:e28. [DOI: 10.1017/s0266462320000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
The frameworks used by Health Technology Assessment (HTA) agencies for value assessment of medicines aim to optimize healthcare resource allocation. However, they may not be effective at capturing the value of antimicrobial drugs.
Objectives
To analyze stakeholder perceptions regarding how antimicrobials are assessed for value for reimbursement purposes and how the Australian HTA framework accommodates the unique attributes of antimicrobials in cost-effectiveness evaluation.
Methods
Eighteen individuals representing the pharmaceutical industry or policy-makers were interviewed. Interviews were transcribed verbatim, coded, and thematically analyzed.
Results
Key emergent themes were that reimbursement decision-making should consider the antibiotic spectrum when assessing value, risk of shortages, the impact of procurement processes on low-priced comparators, and the need for methodological transparency when antimicrobials are incorporated into the economic evaluation of other treatments.
Conclusions
Participants agreed that the current HTA framework for antimicrobial value assessment is inadequate to properly inform funding decisions, as the contemporary definition of cost-effectiveness fails to explicitly incorporate the risk of future resistance. Policy-makers were uncertain about how to incorporate future resistance into economic evaluations without a systematic method to capture costs avoided due to good stewardship. Lacking financial reward for the benefits of narrower-spectrum antimicrobials, companies will likely focus on developing broad-spectrum agents with wider potential use. The perceived risks of shortages have influenced the funding of generic antimicrobials in Australia, with policy-makers suggesting a willingness to pay more for assured supply. Although antibiotics often underpin the effectiveness of other medicines, it is unclear how this is incorporated into economic models.
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