Cefiderocol and ceftazidime-avibactam, two antimicrobial drugs, will be made available on the NHS with the hopes to tackle antimicrobial resistance.
The National Institute for Health and Care Excellence (NICE) has published its draft guidance outlining the value of the two new antimicrobials drugs to the NHS. The evaluations of cefiderocol and ceftazidime-avibactam form part of a project with NHS England and NHS Improvement and the Department of Health and Social Care (DHSC) that aims to incentivise research and the development of antimicrobial drugs by testing new approaches to evaluating and paying for them.
NHS Commercial Medicines Director Blake Dark said: “This is an important step in our world-leading approach to incentivise innovation in antimicrobial drugs and the battle against drug-resistant infections.”
The draft guidance was published on Tuesday, 12 April 2022.
What is antimicrobial resistance?
Antimicrobial resistance (AMR) develops when the pathogens that cause infection evolve to make antibiotics and other antimicrobial drugs less effective or stop them from working.
It has been noted by the World Health Organization as one of the 13 urgent health challenges of this decade, leading to the UK Government outlining its vision for AMR to be contained and controlled by 2040. The five-year National Action Plan will expand and support the vision by investing in innovation, supply and access, recognising that there are very few new antimicrobial drugs being developed.
To tackle AMR, the NHS has developed a subscription-style payment model which aims to address the lack of new antimicrobial drugs. In 2020, only 41 new antimicrobial drugs were being tested in clinical trials compared with about 1,800 immuno-oncology drugs.
Introducing new antimicrobial drugs to the NHS
Investment in new antimicrobial drugs, especially those that target multi-drug-resistant pathogens (known as superbugs), is currently not commercially attractive. This is because antimicrobial drugs are subject to strict controls to restrict their use to minimise the growth of resistance. As a result, sales could be low; however, to mitigate this problem, the new payment method ensures the company will receive a fixed annual fee regardless of prescriptions.
Estimating the full value of the new antimicrobial drugs is a complex process and requires a different economic modelling approach. The current evaluation model focuses on the health benefits, but with antimicrobials, the public health benefits exceed this. For example, effective antibiotics are essential in:
- ensuring that chemotherapy, surgery and other medical procedures can go-ahead
- reducing the spread of infection to other people
- providing a range of treatment options to reduce the risk of resistance developing and be prepared for existing antimicrobials becoming ineffective.
The NICE draft guidance on cefiderocol and ceftazidime-avibactam provides an estimate of their benefits to the health of the overall population 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 domestic markets so that collectively we can achieve a meaningful incentive for global investment in antimicrobials.”