Antimicrobial resistance (AMR) is an urgent global challenge. It causes around 700,000 deaths each year globally. That number is predicted to rise to 10 million by 2050 if no action is taken.
Investing in new antimicrobials is not commercially attractive because, in order to slow the development of resistance, they are subject to strict controls restricting their use. This means sales could be low, and it's difficult for companies to see a return on their investment.
NICE-NHS England pilot project
The UK Government’s 2019 national action plan for AMR included the commitment to test solutions to create an incentive for companies to invest in new antimicrobials, by evaluating and paying for selected products in a different way from other medicines.
To meet this commitment, NICE and NHS England ran a pilot project testing an innovative approach that pays companies a fixed annual fee for antimicrobials, based primarily on a health technology assessment of their value to the NHS, instead of the volumes used.
NICE published guidance on the 2 products selected for the pilot: ceftazidime with avibactam and cefiderocol, in April 2022. This informed commercial discussions between NHS England and the 2 antimicrobial companies involved. The project delivered a global first of awarding subscription style contracts in July 2022, in which payments are delinked from volume used.
The new antimicrobial products subscription model (2024)
Using lessons learnt from the joint pilot, NHS England and NICE developed a more pragmatic approach to determine the value of the contract payments for products that qualify for subscription style contracts.
Following a public consultation on the proposals in 2023, NHS England announced the new commissioning route for antimicrobials in May 2024, and published full supporting documents .
Under the new model, the UK NHS authorities will commission NICE to establish an antimicrobial evaluation panel to make sure the antimicrobial assessment includes the relevant expertise to assess the products against the award criteria. The resulting contracts between the NHS and companies will delink payments from the volume used while having appropriate contractual requirements to guarantee supply.
Documents from the NICE-NHS England pilot project
Final guidance and subscription style contract
View/hide documents
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Final guidance for ceftazidime with avibactam, including evidence considered by the NICE committee.
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Final guidance for cefiderocol, including evidence considered by the NICE committee.
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Subscription style contract agreed with companies (redacted).
Supplier qualification documents
Further information
If you have any questions, please contact the project team at appraisalsAMR@nice.org.uk.