Models for the evaluation and purchase of antimicrobials

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.

The UK Government’s national action plan for AMR includes the commitment to test solutions that address this issue, by evaluating and paying for selected antimicrobial products in a different way from other medicines.

NICE-NHS England pilot project

To meet this commitment, NICE and NHS England ran a pilot project. This project tested 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.

Lessons learnt and public consultation

Using lessons learnt from the joint pilot, NHS England and NICE have developed a more pragmatic approach to determine the value of the contract payments for products that qualify for subscription style contracts.

This approach has been published as part of NHS England’s consultation on proposals for the Antimicrobial Products Subscription Model, a new commissioning route for antimicrobials that offer exceptional value to the NHS. As part of these proposals, the 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 consultation, conducted on behalf of all nations of the UK who may participate in the Antimicrobial Products Subscription Model, is open for 12 weeks from Monday 10 July until midnight on Monday 2 October 2023.

Following the consultation, NHS England, NICE and the devolved governments will consider all relevant feedback. We will then publish a thematic report summarising all the material issues raised, on the NHS England website.

Further information

If you have any questions, please contact the project team at