Important milestone reached in UK’s AMR fight 


The National Institute for Health and Care Excellence (NICE) has published draft guidance recommending the use of two new antimicrobial drugs to be used as part of a subscription style model within the healthcare system.  

NICE has evaluated cefiderocol and ceftazidime–avibactam as part of a project with NHS England and NHS Improvement and the Department of Health and Social Care (DHSC) that is assessing new ways to pay for antimicrobials. The hope is that drug developers will be incentivised to invest research into new antimicrobials knowing they will be reimbursed through the new payment model.  

In 2020 there were only 41 new antimicrobials being tested in clinical trials, compared to around 1,800 immuno-oncology drugs. The new payment model hopes to address this current lack of research and help to combat the growing threat of antimicrobial resistance.  

Cefiderocol and ceftazidime will now be used to treat patients with severe drug-resistant infections who would otherwise have limited or no other treatment options.  

The World Health Organisation (WHO) has highlighted antimicrobial resistance as one the 13 urgent health challenges of this decade1. Antimicrobial resistance develops when the pathogens that cause infection evolve to make antibiotics and other antimicrobial drugs less effective, or stop them from working altogether.  

Pharmaceutical companies have become wary of investing in new antimicrobials because they are subject to controls that restrict their use – due to resistance – thus generating lower sales. The new payment method overcomes this by ensuring a fixed annual fee is paid to the company regardless of how many prescriptions are issued. 

NICE now aims to estimate the full value of new antimicrobials and what their annual fee should be by assessing what impact the drugs have to the health of the overall population in England measured in quality-adjusted life years (QALYs). 

NICE’s draft guidance will now help inform commercial discussions between NHS England and NHS Improvement and the companies to agree payment levels in subscription-style contracts. The payments will not be linked to the actual volumes of drugs used to treat patients in clinical practice but instead reflect the value of holding back new antimicrobials that infections have not become resistant to. 

Official comments  

Nick Crabb, programme director in NICE’s Science, Evidence and Analytics Directorate, said: “This draft guidance represents an important milestone in the UK project. Its ultimate goal is to ensure the NHS has access to effective new antimicrobials to call on when needed and patients aren’t left without treatment options in the face of growing antimicrobial resistance. 

“But we cannot address the global threat of antimicrobial resistance alone, since the UK represents only about 3% of the global market for antimicrobials. We are sharing our learning from this project with international stakeholders and encourage other countries to offer similar incentives in their own domestic markets, so that collectively we can achieve a meaningful incentive for global investment in antimicrobials.” 

NHS Commercial Medicines Director, Blake Dark added: “This is an important step in our world-leading approach to incentivise innovation in antimicrobial drugs and the battle against drug-resistant infections. 

“The NHS will now use its commercial power to secure deals that will enable NHS patients to benefit from these treatments, delivering on its Long Term Plan commitment and paving the way for a pipeline of future treatment options.” 



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