The so-called 3D framework for access to effective antibiotics can be used for all areas of society, such as efforts against antibiotic resistance, investments to develop new antibiotics, policies for safer supplies of antibiotics and assistance to countries with great need for antibiotics.
“Access to effective antibiotics is fundamental for both healthcare and public health. At the same time, measures that improve access and effectiveness can be very costly, and in order to make good decisions, politicians and others must be able to determine whether it is worth the investment,” says Christian Munthe, who is the main author of a scientific article in which the framework was recently presented.
Complex problem picture
The overall problem is complicated and is due, among other things, to the fact that healthcare providers need to limit the use of antibiotics to slow the development of resistance, but still have access to antibiotics. In this case, society may have to pay to get suppliers to continue manufacturing the tablets despite low sales.
The issue also concerns important societal measures, such as improved treatment plants to reduce antibiotic discharges into water, or expanded infrastructure to reduce infection risks in low- and middle-income countries. Another factor is the slow development of new antibiotic preparations. There is agreement that society needs to pay to speed up the process, but there is disagreement about how much each country should pay.
Reverse mindset
“The latter price tag problem has inspired various attempts to expand drug evaluation. Traditional tools only take into account the direct treatment effect. But the importance of antibiotics for all other areas must be weighed up, especially when it comes to infection risks for many types of care, such as intensive care, surgery and cancer care, and by extension also for public health and society at large," says Christian Munthe.
Together with Anders Herlitz at Lund University, and his colleague Erik Malmqvist, Christian Munthe went through these different valuation proposals and found several improvements but also major shortcomings.
"To address the problems, we need to change the very basic view of the value of both antibiotic access and effectiveness. Previous attempts were based on guessing how the value could arise, without explaining what makes it valuable. Then you risk missing a lot. We decided to turn things around, and instead develop a framework that describes all kinds of value that could arise from having sustainable access to effective antibiotics."
Preparedness and public health
Their framework describes three main dimensions of value, which in turn can be broken down into different parts:
• the value of consuming antibiotics, for individuals and for society
• the value of preparedness that provides continuous access to effective antibiotics, regardless of how much they are used.
In the article, the researchers have also described how the framework can be used practically, both in smaller, detailed decisions and in connection with more comprehensive political decisions.
"We also describe how it can be used to help decision-makers not miss important values when balancing what they get against what it costs. In the long run, the same mindset can be used to design new strategies and reforms," says Christian Munthe.
The framework is primarily intended for public decisions on improved antibiotic access, but the article concludes with a discussion of whether similar thinking may also make sense for commercial actors such as pharmaceutical companies.
Links to further reading
The article The 3D Value Framework for Sustainable Access to Effective Antibiotics is published in the journal Health Care Analysis, and can be read by anyone free of charge. Link to the article in Health Care Analysis
The philosophy researchers are also active at the Center for Antibiotic Resistance in Gothenburg (CARe). Link to CARe's website at gu.se
The work has been made possible by the social innovation project Platinea. Link to Platinea, external website
