Two new antimicrobials in NHS pipeline

Tuesday April 12th 2022

Two new antimicrobial drugs could become available on the NHS as part of a deal to accelerate antibiotic drug development, it was announced today.

They will be the first to be made available as part of a new subscription-style payment model following the publication of draft guidance from the National Institute for Health and Care Excellence.

The drugs, cefiderocol and ceftazidime–avibactam, will be used to treat patients with severe drug-resistant infections who would otherwise have limited or no other treatment options.

The NICE evaluations of the drugs form part of a project with NHS England and NHS Improvement and the Department of Health and Social Care (DHSC) that aims to encourage research into and development of antimicrobials by testing new ways of evaluating and paying for them.

The new subscription-style payment model has been designed to address the lack of development of new antimicrobials and the growing threat of antimicrobial resistance, according to NICE.

Investment in new antimicrobials, especially those that target multi-drug-resistant pathogens, is not commercially attractive because they are subject to strict controls to restrict their use to slow the development of resistance, which leads to low sales.

However, the new payment method overcomes this problem by ensuring a fixed annual fee is paid to the company regardless of how many prescriptions are issued.

Estimating the full value of new antimicrobials – and the annual fee – is complex and requires a different economic modelling approach.

While NICE’s evaluation methods focus on health benefits for people that receive the drug, and sometimes their carers, it goes beyond this for antimicrobials, to include enablement value (ensuring chemotherapy, surgery and other medical procedures can go ahead); transmission value (reducing the spread of infection); and diversity and insurance value (providing a range of treatment options to reduce the risk of resistance developing and be prepared for existing antimicrobials becoming ineffective).

NICE used a model developed by the Policy Research Unit in Economic Methods of Evaluation in Health and Care Interventions (EEPRU) to become the first health technology assessment organisation in the world to estimate the full value of an antimicrobial.

The draft guidance on cefiderocol and ceftazidime–avibactam provides an estimate of their incremental net health benefit to the NHS in England, measured in quality-adjusted life years (QALYs).

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.”

NICE will issue final guidance following commercial discussions between NHS England and NHS Improvement and the drug manufacturers.

Tags: NHS | Pharmaceuticals | UK News

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