Scotland’s NHS medicines gatekeeper is putting its weight behind a study looking at a new way to assess the cost effectiveness of antibiotics in the hope of addressing the shortage of new antimicrobial medicines being brought to market.

Currently, drugs companies are paid by volume of antibiotics sold, while the NHS is trying to reduce their use to prevent antimicrobial resistance (AMR).

Health services, researchers and pharmaceutical companies have spent many years trying to come up with an alternative approach to the current model which makes it unattractive to plough millions of pounds into developing new antibiotics which might sell in very small numbers – if at all – because they are only meant to be used as a last resort.

In an announcement today, the Scottish Medicines Consortium (SMC) says it, alongside the government’s Scottish Antimicrobial Prescribing Group and NHS Scotland’s national procurement team are involved as formal observers in a pilot of a subscription model being run in England.

The SMC’s opposite number, the National Institute for Health and Care Excellence (NICE) is working with NHS England to test the new health technology evaluation process for antimicrobials.

The pilot will look at a value-based approach where the NHS makes subscription payments for two antimicrobial medicines even though they might only be prescribed on rare occasions.

The medicines – ceftazidime/avibactam (Zavicefta made by Pfizer) launched in 2017 and cefiderocol (Fetcroja made by Shionogi) launched in 2020 – are both active against Gram negative bacteria including resistant strains of E. coli and Klebsiella.

The SMC says that it will not issue any advice to NHS Scotland on these medicines during the pilot, which is expected to be completed early next year – adding that the medicines will still be available to infection specialists in Scotland if needed.

AMR – where bacteria develop resistance to routinely available antibiotics – is thought to lead to 700,000 deaths a year across the world.

Read more: Dentists’ key role in reducing antibiotics; Drop in antibiotics used for respiratory infections; Safeguarding antimicrobial use in a pandemic

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