A new model for evaluating and purchasing antimicrobials in the UK

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 details of the new commissioning route for antimicrobials in May 2024, and launched the first round of procurement in August 2024.

Under the new model, the UK NHS authorities are commissioning NICE to establish an antimicrobial evaluation panel to make sure the antimicrobial assessment includes the relevant expertise to assess the products against the evaluation criteria. The resulting contracts between the NHS and companies will delink payments from the volume used while having appropriate contractual requirements to guarantee supply.

For further information about the UK’s ambitions and actions supporting the 20-year vision for antimicrobial resistance (AMR), see the UK 5-year action plan for antimicrobial resistance 2024 to 2029 (this is the UK’s second national action plan, following the UK 5-year action plan for antimicrobial resistance 2019 to 2024).

If you have any questions, please contact the project team at appraisalsAMR@nice.org.uk.