Estimation of ‘spectrum value’: A discrete choice experiment to investigate the willingness-to-pay for narrow-spectrum based on other antimicrobial characteristics
Date
2026
Authors
Hillock, N.T.
Chen, G.
Merlin, T.L.
Louise, J.
Turnidge, J.
Karnon, J.
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Advisors
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Journal article
Citation
Applied Health Economics and Health Policy, 2026; 24(3):1-13
Statement of Responsibility
Nadine T. Hillock, Gang Chen, Tracy L. Merlin, Jennie Louise, John Turnidge, Jonathan Karnon
Conference Name
Abstract
Abstract Background Narrow-spectrum antimicrobials are likely to drive fewer antimicrobial resistances. However, they may be more expensive than broad-spectrum alternatives. Objective To determine the preferences of antimicrobial stewardship (AMS) experts regarding antimicrobial choice relative to relevant pharmacological and economic attributes, and how those attributes impact their willingness-to-pay for narrowspectrum of activity. Methods Two discrete choice experiments (DCEs), consisting of six pharmacological and economic attributes, were administered via an online survey to Australian infectious disease physicians, clinical microbiologists and hospital AMS pharmacists. Respondents were asked to complete each DCE from a public hospital perspective, assuming 100 or 1000 patients would be treated each year, respectively. A conditional logit model was used to analyse the DCE data. Results 155 respondents participated in one or both DCEs. Antimicrobial price, spectrum of activity, administration route, and public funding significantly affected drug choice in both scenarios (p < 0.001). Whether the antimicrobial was a novel class did not significantly impact choice. As the price of a narrow-spectrum antimicrobial increased, it became less preferred compared to a broad-spectrum cheaper alternative. With all other attributes being equal, participants were willing to pay an additional AU$862 for the narrow-spectrum option (95% CI $726–$998). Conclusions While narrow-spectrum antimicrobials are preferred for targeted therapy by health practitioners with AMS expertise, price significantly influenced drug choice. Willingness-to-pay values reflect the knowledge and experience of AMS experts who are best-placed to gauge the opportunity costs of paying more for narrow-spectrum antimicrobials. These findings can inform the quantification of spectrum-value for health-system funding decisions.
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© The Author(s) 2026. This article is licensed under a Creative Commons Attribution- NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.