ABSTRACT
Objectives: Traditional health economic evaluations of antimicrobials and other therapeutics such as vaccines currently underestimate their value to wider society. It can be supplemented by additional value elements including insurance value, which captures the value of a novel antimicrobial in preventing or mitigating impacts of adverse risk events such as those related to Covid-19 and antimicrobial resistance (AMR). Despite being commonplace in other sectors, constituents of the impacts and approaches for estimating insurance value of therapeutics have not been investigated. Method(s): This study assessed the insurance value of a novel antimicrobial, from the operational healthcare costs and several wider population health and societal perspectives. This was done by: (1) identifying risk events pertaining to 4 relevant scenarios: ward closures, unavoidable shortage of conventional antimicrobials, viral respiratory pandemics and catastrophic AMR, through literature review and multidisciplinary expert workshops, (2) parameterising constituent mitigable costs and frequencies of the risk events, and (3) applying a Monte Carlo simulation model for extreme events, and a dynamic disease transmission model. Modelling was implemented in Excel and R. Result(s): The mean insurance value across all scenarios and perspectives was 718m over a 10-year period, should AMR levels remain unchanged, where only 134m related to operational healthcare costs. The viral respiratory pandemics and catastrophic AMR scenarios contributed most to this value (290m and 297m respectively). This overall value would be 50-70% higher if AMR levels steadily increased or if a more risk-averse view (1-in-10 year downside) of future events is taken. Conclusion(s): The insurance value of a novel antimicrobial can be systematically modelled, and substantially augments their traditional health economic value in normal circumstances. These approaches are generalisable to any health intervention, and form a framework for health systems and governments to recognise broader value in health technology assessments and increase resilience by planning for adverse scenarios. Copyright © 2022