Amidst rising levels of antimicrobial resistance, the National Health Service (NHS) in England is ramping up plans to lure pharmaceutical companies away from volume-based sales to incentivise research into new treatments. 

Last year, the NHS initiated a pilot study with antibiotics from Pfizer and Shionogi in what was a world-first subscription contract model. After England’s National Institute for Health and Care Excellence (Nice) estimated Pfizer’s Zavifecta (ceftazidime–avibactam) and Shionogi’s Fetroja (cefiderocol) value to the NHS, the pharma giants put pen to paper to design a new reimbursement model.

Now, the NHS has greenlit a consultation to investigate possible expansion to the scheme. Over the next three months, the healthcare service will enlist the help of the pharmaceutical industry, patients, carers, and academics to discuss proposals of doubling annual payments for antibiotic contracts from £10 million ($13 million) to £20 million ($26 million) where “outstanding clinically based criteria are met.”

David Glover, assistant director of medicines analysis at NHS, said: “As we continue to take lessons from the Covid-19 pandemic, the development of new antibiotics is absolutely essential to help build resilience to respond rapidly to new superbugs and save lives.”

The proposals include prioritisation of drugs that cover the 12 families of bacteria listed by the World Health Organisation (WHO) that pose the greatest threat to human health. When publishing the list in 2017, the WHO said new antibiotics for bacteria such as Acinetobacter, Pseudomonas, and Enterobacteriaceae are urgently needed.

The scheme is part of a five-year action plan by the UK government to tackle antimicrobial resistance. Stewardship programs prioritise and limit the use of novel antimicrobial drugs to prevent the emergence of resistance. However, the reduced use of novel drugs has resulted in a smaller financial payoff for biotechs developing these drugs. A subscription payment model removes any financial motivation for the overuse of antibiotics, and could also address the lack of new antimicrobials being developed compared to other indication areas, such as immuno-oncology.

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Whilst the UK has managed to reduce antibiotic prescription numbers, drug-resistant infections in patients are continuing to rise. A review by the UK government and Wellcome Trust indicated that antibiotic resistance leads to 50,000 deaths each year in Europe and the US alone.

Accurately calculating the value of novel medications like new antimicrobials has been a consistent challenge.  Talking in a statement announcing the expansion plans, Nick Crabb, programme director in NICE’s Science, Evidence and Analytics Directorate, said the institute is encouraging other countries to use learnings from the project to combat antimicrobial resistance on a global scale.  The US, for example, has rolled out its own subscription payment models for antiviral treatment of Hepatitis C.