Intended for healthcare professionals


Subscription model for antibiotic development

BMJ 2019; 366 doi: (Published 06 September 2019) Cite this as: BMJ 2019;366:l5364
  1. Rebecca E Glover, research fellow,
  2. John Manton, assistant professor,
  3. Sam Willcocks, research fellow,
  4. Richard A Stabler, associate professor
  1. Antimicrobial Resistance Centre, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to: R Stabler Richard.Stabler{at}

An unlikely answer to the global crisis in antibiotic resistance

In July 2019 the National Institute for Health and Care Excellence (NICE), NHS Improvement, and NHS England announced that they will trial a “subscription model” when paying for new classes of antibiotics.1 This incentive for antibiotic research and development decouples payments to drug companies from the volume of antibiotics sold, to help encourage new products to market.

The model will use a health technology assessment process to identify a base “value” that the NHS would pay to pharmaceutical companies annually, regardless of how many prescriptions are issued. There may also be a small cost for each prescription, but the details of this new incentive have yet to be announced. The scheme’s relation to existing means of valuing antibiotics and to related strategies for infection control requires scrutiny.

Global problem

Antibiotic resistance is recognised as a major global problem. Only one antibiotic in a new class, teixobactin, has been discovered in the past 30 years, and it was developed …

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