How the ‘NHS model’ to tackle antimicrobial resistance (AMR) can set a global standard

NHS England and Improvement, in collaboration with the National Institute for Health and Care Excellence (NICE) and the Department of Health and Social Care (DHSC), has selected the first antimicrobial drugs to be purchased via the UK’s innovative ‘subscription-type’ payment model.

NHS England and Improvement project leads, Mark Perkins and David Glover, discuss this important step in tackling antimicrobial resistance (AMR).

AMR refers to the process by which microorganisms develop defences against antimicrobial drugs, enabling these microorganisms to adapt and become resistant to treatment. It’s a serious problem and has recently been identified as one of the World Health Organization’s top 13 global health challenges in the next decade. Without working antibiotics, routine surgery like caesarean sections or hip replacements will become too dangerous to perform, cancer chemotherapy will become prohibitively high-risk and certain infections will require long and complex treatment; or will no longer be treatable.

Already, the microorganisms that cause many common diseases around the world – including tuberculosis, malaria, gonorrhoea, urinary tract infections and chest infections – can resist a wide range of antimicrobial medicines.

Like all global challenges, leaders in the international community need to come forward and act on AMR, and the UK – with the NHS as the world’s largest single public health system – is taking the initiative.

Today marks the latest milestone in our ‘subscription-style’ payment model for antimicrobials. This new model will incentivise companies to invest in this critical area, to help secure a pipeline of future treatment options for NHS patients.

Following a rigorous process with expert clinical input, two treatments, Cefiderocol (Fetcroja) manufactured by Shionogi, and ceftazidime with avibactam (Zavicefta) manufactured by Pfizer, have been selected to move to an innovative health technology evaluation process.

Fetcroja is licensed for treating infections due to aerobic Gram-negative organisms in adults with limited treatment options. Zavicefta is a combination antimicrobial licensed for the treatment of a number of infections, including intra-abdominal and urinary tract infections, as well as hospital-acquired pneumonia.

The evaluation process will be undertaken by NICE, applying its internationally recognised methods over the next 12 months. The output of these evaluations will inform the subscription payment price each company will receive for its product(s). It is anticipated that these products will be made available to patients via a subscription-based payment model from early 2022.

This project is setting an example to the world that this type of approach is feasible. We continue to share our learning with international partners and encourage them to consider similar models within their own healthcare systems. By other countries following suit, working with partners in industry, collectively we can reinvigorate the antimicrobial development pipeline.

This project will support delivery of the ambitions of The UK’s 20 year vision for antimicrobial resistance, in terms of driving innovation that will support the development of new antimicrobials and support sustainable supply and access to products in the future.  Moreover, one of the key commitments in The UK’s five-year national action plan to tackle AMR was to ‘Develop and test new models for national purchasing arrangements that de-link the price paid for antimicrobials from the volumes sold, using a NICE led healthcare technology assessment to support robust stewardship’.

The idea of the payment approach is to move away from paying for individual packs of antimicrobials and, instead, make an annual payment based on the health benefits to patients and the value to the NHS.

Today is an important step in demonstrating that this payment model can be a ‘win, win’ for health systems and industry – NHS patients will be able to benefit from a secure supply of new antimicrobial drugs, while pharmaceutical companies will be able to reliably forecast their return on investment.

Our world-leading commercial capabilities are enabling the NHS to confront the challenge of AMR head-on, by working closely with NICE, DHSC and industry partners like Shionogi and Pfizer to accelerate research and investment in antimicrobials.

With this innovative project, we can show health system leaders around the world how, through a global effort, we can mitigate the risk of AMR by getting the larder stocked with effective drugs for when patients need them.

At the time of her appointment as UK Special Envoy on AMR in June 2019, Dame Professor Sally Davies said, “The UK should be proud of its world-leading work on AMR” noting however that “AMR is a complex challenge which needs local, national and global action”. Getting us to where we are today has been the result of national collaboration, steered by a global imperative and that will require local support to deliver sustainable treatment to patients.

COVID-19 has demonstrated the abilities of our healthcare systems and life sciences industry to do remarkable things when focussed on a shared goal. AMR, like COVID-19, is a global challenge that requires a multi-sectoral approach across healthcare, but also agriculture, sanitation and many other areas. Today is a small step that can point the way toward a giant leap to tackle a great challenge for mankind.

Mark Perkins

Mark became Head of Strategic Category Management at NHS England and NHS Improvement in April 2020, as part of the Commercial Medicines Directorate’s Medicines Value Team. He has 15 years’ experience within the NHS of working collaboratively with industry to design and deliver innovative, world class and award-winning, commercial deals to help improve clinical outcomes and value for the NHS. Prior to joining the NHS, Mark held executive level commercial and operational roles within the private sector.

David Glover

David Glover became Deputy Head of the Medicines Analysis Team at NHS England and Improvement, in January 2019. Prior to joining the NHS, David worked in central government for over 20 years, including 15 years as an economic adviser to the Department of Health and Social Care and the Office for Life Sciences, having also spent six years as a patent examiner at the UK Intellectual Property Office.