New antibiotics: NHS will test “pay for usefulness” model to stimulate research
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4610 (Published 09 July 2019) Cite this as: BMJ 2019;366:l4610
The NHS will pay drug companies up front for access to new drugs depending on their usefulness, in an effort to encourage them to invest the £1bn (€1.11bn; $1.25bn) or more needed to bring a new antibiotic to market.
This trial in incentivising companies to focus on developing drugs that may be held in reserve is a move away from the usual way the NHS pays for drugs, which is based on how much they are used.
The drug industry has been reluctant to invest in the research and clinical trials necessary to bring new antibiotics to market because of low returns. The “subscription-style” payment model is seen as a world first.
England’s health secretary, Matt Hancock, said, “Superbugs are increasing, but we have nothing to combat them with: it’s time to refocus our efforts on quality, not quantity.
“Our NHS is in a unique position to take a global lead in testing new payment models. We will take the lead, but this is a global problem and we cannot succeed alone.”
Shared learning
Resistant bacteria already cause more than 700 000 deaths worldwide every year, and efforts have been made to preserve antibiotics while encouraging new investment in the field.
Last month the World Health Organization launched a tool that shows governments which antibiotics to use for common or serious infections and which to use only as a last resort.1 And in January the UK’s five year national action plan on antimicrobial resistance set targets to reduce human use of antibiotics in the UK by 15% by 2025 and to reduce the incidence of a specified set of drug resistant infections.2
Announcing the new scheme on 9 July, Nicola Blackwood, health minister, said, “This project is an important step, but it will only address global market failure if other countries do the same, which is why we want to involve as many countries as we can and share our learning from this work.
“Today we are sending a strong signal to the rest of the world that there are workable models to stimulate investment in these vital medicines and that together we can tackle AMR [antimicrobial resistance].”
NHS England, the Department of Health and Social Care, and the National Institute for Health and Care Excellence will also develop and test a new model to assess the added value of new antimicrobials. They are asking companies to identify products to be considered for the initial phase of the test. The work will be evaluated and shared with the rest of the world so that other healthcare systems can test similar models.
England’s chief medical officer, Sally Davies, who leaves her post at the end of September and will become the first special envoy on antibiotic resistance, said, “If antibiotics no longer work, it would signal the end of modern medicine. It is now not enough to simply cut antibiotic use: we urgently need to find new ones to win the war against the superbugs that are resistant to multiple drugs.
“We must stimulate investment in the development of new antimicrobials, and this is the world’s first attempt to do exactly that.”
The government has also announced £2m for an education campaign this October to help reduce the inappropriate use of antibiotics.