OBJECTIVES: Since the peak of antibiotic discovery in the 1950’s, identification of new classes has been largely void; a concern as resistance grows. One barrier to discovery is poor revenue generation as new products are used in last-line. To incentivise discovery, “Netflix”-style pricing models were proposed, where there is fixed-fee reimbursement irrespective of the volume used. To understand how this addresses the shrinking antibiotic pipeline, we analysed subscription-based agreements for antibiotics in Europe and made future predictions.

METHODS: Antibiotics and antibacterials assessed by the European Medicines Agency (EMA), since its formation, were filtered removing withdrawn or generic applications, and submissions per year were counted. Subsequently, European antibiotic subscription-based models were identified from national reimbursement agencies and commentary on their motives were hypothesised. Finally, pipeline antibiotics were visualised, overtime, by analysing World Health Organisation (WHO) data.

RESULTS: The EMA has approved only 21 new antibiotics since 1995. We identified two European countries who have used subscription-based models to incentivise development. The UK announced in 2022 that two antibiotics will enter this type of model and Sweden are trialing this model for five antibiotics since 2014. WHO data show an upward trend in pipeline antibiotics since 2017.

CONCLUSIONS: Though subscription-based models correlate to the rise in pipeline antibiotics, it is unclear if they are the cause as other factors must be considered. Nevertheless, guaranteed revenue following successful negotiation is likely favourable to manufacturers. It will be interesting to monitor future increases in the antibiotic pipeline and similar agreements for antibiotics entering European markets. Subscription-based models for hepatitis C are also being used in Australia and the US to gain greater coverage for expensive treatments. We speculate that subscription-based models may expand into therapy areas with uncertainty over patient numbers or how frequently the treatment may need to be administered.