Description: The UK Government’s 2019 national action plan for AMR committed to testing an incentive for companies to invest in new antimicrobials. To meet this commitment, NICE and NHS England ran a pilot using a world-first approach that pays companies a fixed annual fee for antimicrobials regardless of volumes used. Payment was based on a bespoke NICE health technology assessment, using quantitative health economic analyses to estimate population-level benefits in quality-adjusted life years for 2 drugs. Innovative modelling incorporated public health benefits, used in vitro data as a surrogate for clinical outcomes, and projected AMR trends using national surveillance data. Stakeholders from the pharmaceutical industry, academia and clinical practice, and international key opinion leaders, participated in workshops to review lessons learned.

Lessons Learned: The pilot demonstrated feasibility of delinking payments from volumes within public procurement systems, and produced the most comprehensive valuation of antimicrobial products to date. Net health benefit estimates justify paying the UK’s ‘fair share’ towards antimicrobial research and development. But modelling antimicrobial value is resource-intensive and subject to high uncertainty. Collectively, these learnings have led to a more pragmatic approach to determining contract value: a multi-criteria decision analysis (MCDA) tool, which NICE and NHSE have co-developed (informed by drivers of value identified in the pilot, validated by clinical experts from the UK Government, and subjected to public consultation in 2023). It will be implemented in a UK-wide Antimicrobial Product Subscription Model from summer 2024, using a single procurement process across regional healthcare systems. It is hoped this approach will be scalable and adaptable in other countries, to collectively achieve a meaningful incentive for global investment in antimicrobials.

Stakeholder Perspective: Payer, government