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Steve Halasey, chief editor, CLP

At the beginning of June, the Obama Administration convened a special “White House Forum on Antibiotic Stewardship” as part of its continuing efforts to combat antibiotic resistance. The event brought together key human and animal health constituencies involved in antibiotic stewardship—the development, promotion, and implementation of activities to ensure the responsible use of antibiotics.

For many, the wide range of organizations participating in the forum may have been something of a surprise. Moreover, as part of the event, more than 150 food companies, retailers, and human and animal health stakeholders highlighted their commitments to implement changes over the next 5 years to slow the emergence of resistant bacteria and prevent the spread of resistant infections.

As described in this issue’s Inside Track column, forum attendees had a great deal to say about the dangerous state of antibiotic resistant organisms worldwide, including the important role of diagnostic testing for reducing the pace at which such resistance is spreading. Speaking on behalf of IVD industry association AdvaMedDx, Cepheid CEO John Bishop took advantage of the opportunity to remind policymakers that the development and adoption of advanced diagnostics requires more than mere commitments:

As the critical first step in any strategy to combat resistance, we should accelerate the availability of appropriate diagnostics in all healthcare settings, particularly at the point of need. Primary care physicians need fast and accurate diagnostic information that differentiates viral from bacterial infections, so that they can prescribe more targeted antibiotic treatments against the right organisms to help slow the development of resistance.

Diagnostics should be fairly reimbursed by payors. The cost of the diagnostic is almost always very small compared to expensive hospitalizations or therapies. Under a fee-for-service reimbursement model, fees should be value-based to reflect the diagnostic contribution to improving patient outcomes and reducing overall cost to the health system. Under a value-based purchasing or bundled payment model, value needs to reflect cost offsets to other parts of the healthcare system, such as reductions in hospitalization, pharmacy, readmissions, or post-acute care. Robust quality metrics need to be developed to reflect evidence-based best practices, and payment incentives need to be implemented around appropriate use of diagnostics to drive desirable patient health outcomes.

Finally, we need to continue to invest in building the global public health infrastructure for infectious disease surveillance. Many significant advances have been made in the private sector, and we encourage the agencies to continue to leverage those capabilities.

Curiously, while IVD manufacturers were well represented at the forum, only a handful of clinical laboratories and related professional associations were among the organizations making commitments to the goals of the event.

However such an oversight may have occurred, laboratorians would do well to see that it is not repeated. Lab professionals play important roles in the development, refinement, performance, and analysis of diagnostic tests and testing methodologies, and it is fundamentally important that the lab portion of the diagnostic community be fully involved in efforts to diagnose and monitor instances of antibiotic resistance. Anything else would be considerably less than a full showing of commitment from the clinical lab community.

Steve Halasey
Chief Editor, CLP
[email protected]
(626) 219-0199