How Should the Value Attributes of Novel Antibiotics Be Considered in Reimbursement Decision Making?

Antibiotics have revolutionized the treatment of bacterial infections. However, it is widely held that there is underinvestment in antibiotics research and development relative to the socially optimal level for a number of reasons. In this article, we discuss whether existing health technology assessment procedures recognize the full economic and societal value of new antibiotics to patients and society when making reimbursement decisions. We present three recommendations for modelling the unique attributes of value that are specific to novel antibiotics. We find, based on a review of the literature, that some of the value elements proposed by our framework have previously been discussed qualitatively by health technology assessment bodies when evaluating antibiotics, but are not yet formally captured via modelling. We present a worked example to show how it may be possible to capture these dimensions of value in a more quantitative manner. We conclude by answering the question of the title as follows: the unique attributes of novel antibiotics should be considered in reimbursement decision making, in a way that captures the full range of benefits these important technologies bring to patients, health care systems, and society.

A Perspective on Incentives for Novel Inpatient Antibiotics: No One-Size-Fits-All.

The need for new "pull" incentives to stimulate antibiotic R&D is widely recognized. Due to the global diversity of health systems, combined with different challenges faced by antibiotics used in different types of healthcare settings, there is no one-size-fits-all solution. Instead, different "pull" incentives should be tailored to local contexts, priorities, and antibiotic types. Policymakers and industry should collaborate to identify appropriate solutions at the local, regional, and global levels.

Diagnosis Confirmation Model: A Value-Based Pricing Model for Inpatient Novel Antibiotics.

The Diagnosis Confirmation Model (DCM) includes a dual-pricing mechanism designed to support value-based pricing of novel antibiotics while improving the alignment of financial incentives with their optimal use in patients at high risk of drug-resistant infections. DCM is a market-based model and complementary to delinked models. Policymakers interested in stimulating antibiotic innovation could consider tailoring the DCM to their reimbursement systems and incorporating it into the suite of incentives to improve the economics of antibiotics.

Dental insurance, income and the use of dental care in Canada.

Using recent Canadian health survey data, we investigated the effect of socioeconomic status on patients' use of dental services and dental insurance coverage. Our results point to an important socioeconomic gradient in the use of dental services. The probability of receiving any dental care over the course of a year increases markedly with dental insurance, household income, and level of education. Among those receiving at least some dental care, however, a person's general oral health--not financial factors--largely determined visit frequency. The insurance effect appears to operate through a reduction in price paid at point of service, not decisions by those with high anticipated need for dental care to selectively purchase insurance. Indeed, those with poorer self-assessed oral health, as well as those from Quebec (where dental benefits are subject to personal income tax) and those over 65 years of age (who have likely lost employer provided coverage) were less likely to be insured.