The 3D Value Framework for Sustainable Access to Effective Antibiotics.

Sustainable access to effective antibiotics is a main rationale for addressing antimicrobial resistance, for calls to enhance antibiotic supply security and for development support to promote health system capacity in low- and middle-income settings. Standard models for valuing pharmaceuticals fail to capture the full value of sustainable access to effective antibiotics. In effect, assessments of societal or corporate investments to promote such access underestimate their value and the cost of foregoing them. In effect, measures that could address existing sustainability problems in antibiotic supply systems are hampered. We review the features needed to avoid these problems and assess suggestions to address the flaws of existing approaches, such as the STEDI-model. On this basis, we propose the 3D Value Framework, a straightforward and comprehensive model that focusses directly on what types of valuable outcomes there can be related to having sustainable access to effective antibiotics. We also sketch how this model can be used in cost-effectiveness analysis grounding public decision-making and discuss further applications in other settings.