OBJECTIVES: Many novel antibiotics are intended to be effective against pathogens resistant to Standard of Care (SoC) antibiotics and attenuate progress of antimicrobial resistance. This study investigates the cost of novel antibiotics in UK and Germany compared to generic SoC and discusses opportunities that may remove barriers to use and offer increased value.

METHODS: Approved systemic IV and oral antibiotics (01/2010 – 06/2020) were extracted from the EMA website and pricing databases were reviewed to identify respective ex-manufacturer list prices in the UK and Germany. Antibiotics not commercially available/without publicly available pricing were excluded. Qualitative semi-structured interviews (n=10) were conducted with UK and Germany key clinical stakeholders to review the impact of price on utilization.

RESULTS: Data for 9 novel antibiotics were analysed. 3 were approved for use in gram-negative infections, 5 in gram-positive, and 1 in gram-positive/negative. Cost of treatment with novel antibiotics (drug cost) compared to SoC antibiotics was on average 5X higher (range 1.4X – 16.2X). All novel antibiotics listed were restricted to 2^nd or 3^rd line use (once causative pathogen has been suspected/established). Respondents noted that cost is one of the key reasons novel antibiotics are restricted to 2^nd or 3^rd line use. In addition, they noted that the real-life value of novel antibiotics compared to SoC is more difficult to establish whilst their use is restricted to patients who have failed several therapies, often with complicated infections.

CONCLUSIONS: As clinical experience increases, using these therapies in earlier lines where their comparative effectiveness against resistant pathogens can be better evaluated - as well as their benefit towards antimicrobial resistance stewardship - would help to demonstrate value. A subscription-based pricing structure may be one option to facilitate this.