Why Britain’s subscription model is trying to make antimicrobial stewardship compatible with pharmaceutical innovatio
| There is something economically strange about a good antibiotic. We want it to exist. We may one day need it desperately. Yet if the health system is doing its job, we hope to use it as little as possible. The NHS antimicrobial subscription model begins with that paradox—and asks a larger question: how do you pay for preparedness? |
The argument in one minute
| The market failure | Normal pharmaceutical economics rewards volume; good antimicrobial stewardship deliberately suppresses volume. |
| The UK experiment | NICE and NHS England tested delinked annual payments for cefiderocol (Shionogi) and ceftazidime–avibactam (Pfizer), with value assessed at population level. |
| The permanent model | Products compete for subscription contracts. In England the published bands are £5m, £10m, £15m or £20m per year, depending on assessed value; each UK nation sets its own values. |
| What 2026 tells us | The next awards have not yet been announced. Parliament was told in June 2026 that awards are likely in November 2026, with contracts commencing in Q1 2027. |
| The real test | Success is not the existence of a clever contract. It is whether delinked payment changes R&D investment, strengthens supply, protects stewardship and improves patient care. |
1. The medicine we hope not to use
There is a small tragedy hidden inside the economics of antibiotics. A company can discover a medicine that an intensive-care physician may one day regard as priceless, and still discover that the market regards it as commercially disappointing.
The reason is not mysterious. An ordinary medicine is rewarded when it is used. A statin earns revenue because millions of people take it repeatedly. An oncology medicine earns revenue because eligible patients receive it. In the familiar pharmaceutical equation, commercial success and utilisation broadly travel in the same direction.
A strategically important antimicrobial is different. The moment it arrives, microbiologists, infectious-disease physicians and antimicrobial stewardship teams may do exactly what society needs them to do: protect it. They may reserve it for the patient whose organism is resistant to older agents, wait for microbiology, restrict empirical use, review treatment daily and stop it as soon as it is no longer needed.
That is good medicine. It is also a poor recipe for conventional sales growth.
The contradiction matters because antimicrobial resistance is not an abstract threat. The 2022 Lancet analysis of the 2019 global burden estimated 1.27 million deaths directly attributable to bacterial antimicrobial resistance and 4.95 million deaths associated with it (Antimicrobial Resistance Collaborators, 2022). The later Global Burden of Disease analysis estimated 1.14 million attributable deaths in 2021 and forecast that, without sufficient progress, attributable deaths could reach about 1.91 million in 2050 (GBD 2021 Antimicrobial Resistance Collaborators, 2024).
England’s own surveillance keeps the problem painfully contemporary. The UK Health Security Agency’s 2026 ESPAUR report counted 20,484 antibiotic-resistant bacteraemia episodes in 2024, 13.1% more than in 2019; Enterobacterales accounted for 85.1% of resistant cases. At the same time, the UK is trying to reduce human antibiotic consumption and increase the proportion of use drawn from the WHO Access group. Resistance demands new medicines; stewardship demands that we use medicines more intelligently. A viable reimbursement system must somehow do both.
2. A market designed to fail
The phrase “broken market” is used so often in antimicrobial policy that it can sound like a slogan. It is better understood as a structural mismatch between what society needs and what the normal market rewards.
The scientific difficulty comes first. Antibiotic discovery is technically hard, especially against highly resistant Gram-negative organisms. Development programmes must find patients who are ill enough to demonstrate clinical value yet sufficiently well characterised for trials. Regulatory approval is only the beginning. The new medicine then enters a clinical culture properly designed to conserve it.
Euan Barlow, Alec Morton, Itamar Megiddo and Alec Colson approached this as an optimisation problem rather than a slogan. Their 2022 work on subscription models showed that the right contract depends on the role of the antimicrobial: a medicine whose value lies in preventing transmission does not necessarily require the same incentive design as a last-line reserve agent. The important point is that “subscription” is not itself the answer. The contract must be engineered around the public-health purpose of the product (Barlow et al., 2022).
Colm Leonard, Nick Crabb and colleagues from NICE and NHS England described the British logic from the inside in 2023. The new arrangements that began on 1 July 2022 were deliberately framed as a pull incentive: reimbursement was separated from sales volume and instead linked to the added value of the antimicrobial to the whole health and social-care system (Leonard et al., 2023).
Kevin Outterson and John Rex called the UK approach a global lead because it tackled the perverse incentive at its source: if revenue no longer rises with units sold, manufacturers can be rewarded for innovation without being commercially rewarded for encouraging unnecessary prescribing (Outterson & Rex, 2023).
This is the unusual thing about the NHS experiment. It does not ask stewardship to bend to the market. It asks the market to bend to stewardship.
3. The NHS answer: separate value from volume
NHS England describes the principle plainly. Rather than paying primarily according to how much antimicrobial is used, the health service pays selected companies a fixed annual amount based on the product’s value to the NHS. NICE provides the expert evaluation machinery; NHS England leads the procurement; the devolved nations may participate through the same process and decide whether to contract and what to pay in their own jurisdictions.
The first pilot products were cefiderocol, marketed by Shionogi as Fetcroja, and ceftazidime–avibactam, marketed by Pfizer as Zavicefta. Both companies publicly described the arrangement as a move away from volume-linked remuneration. That is why the phrase “Netflix model” stuck: one pays for access rather than for each individual use.
The nickname is memorable and slightly misleading. Netflix is entertainment on demand. A reserve antimicrobial is closer to a fire engine, an ICU bed or an insurance contract. Its value is partly realised in the moment it is used, but partly in the fact that it is reliably there when ordinary options have failed.
The permanent Antimicrobial Products Subscription Model has made the machinery more explicit. Products must clear eligibility requirements, including clinical criteria tied to priority pathogens, security of supply, stewardship commitments, environmental manufacturing standards, financial standing and social-value requirements. NICE then convenes a UK expert panel to score eligible products against published award criteria. The score determines whether a subscription is offered and, in England, which value band applies.
England’s published annual value bands
| Band | Annual value in England | Description / score |
| 1 | £20 million | Breakthrough antimicrobial — ≥80% of maximum score |
| 2 | £15 million | Critical new antimicrobial — 70–79% |
| 3 | £10 million | Priority new antimicrobial — 60–69% |
| 4 | £5 million | Important new antimicrobial — 50–59% |
Important: these monetary values are for England. NHS England’s guidance states that each UK nation determines the values that apply in its own health system.
The contract also changes behaviour outside price. NHS England requires companies to support surety of supply and to delink sales-force remuneration incentives from antimicrobial sales. Promotion must be informative and educational. Environmental standards matter because antibiotic residues from manufacturing can themselves contribute to resistance. The model is therefore trying to shape an ecosystem, not merely negotiate a discount.
Contracts are initially three years, with possible extensions of up to three years at a time, to a maximum total of 15 years. A product can move between value bands as its value changes. This is an important design feature: a subscription is not intended to fossilise an estimate of value made on launch day.
4. The people who tried to price preparedness
A reimbursement mechanism becomes interesting when one asks what had to happen intellectually before the contract could exist. In Britain, that work began years before the first subscription cheque.
In 2018 Claire Rothery, Beth Woods, Laetitia Schmitt, Karl Claxton, Stephen Palmer and Mark Sculpher—working through the economic-evaluation policy research unit spanning York and Sheffield—set out a framework for valuing new antimicrobials under alternative funding arrangements. The problem was already clear: conventional patient-level cost-effectiveness could miss value created across a population and over time (Rothery et al., 2018).
The later evaluation led by Beth Woods at the Centre for Health Economics, University of York, with Ben Kearns, Sue Harnan and colleagues at Sheffield, and clinicians and experts from Leeds, Liverpool, Manchester and NHS England, shows how difficult that ambition became in practice. Their 2025 paper is one of the most important accounts of the NHS experiment because it records the collision between a clean economic idea and messy clinical reality (Woods et al., 2025).
They had to define who would actually receive cefiderocol or ceftazidime–avibactam, estimate comparative effects across heterogeneous infections, make use of susceptibility data where directly relevant clinical trials were sparse, forecast future resistant infections and then translate all of that into population incremental net health effects. The resulting estimates were highly uncertain—not because the researchers were careless, but because the object being valued was partly a future that had not happened yet.
That is an unusually honest lesson for health technology assessment. There are technologies for which uncertainty is not a temporary inconvenience that disappears with one more trial. Sometimes the uncertainty is intrinsic to the value proposition.
5. STEDI: the value that does not sit in the vial
The literature has given this wider antimicrobial value a memorable shorthand: STEDI—Spectrum, Transmission, Enablement, Diversity and Insurance. Simon Brassel, Amer Al Taie and Lotte Steuten examined the framework in 2023 and cautioned against treating it as a mechanical checklist. The value of each component depends on the product, pathogen, setting and decision problem (Brassel et al., 2023).
Spectrum
A targeted antimicrobial may avoid collateral damage to the microbiome and reduce selection pressure on organisms that do not need to be exposed. The value is ecological as well as individual.
Transmission
Effective treatment can reduce the opportunity for a resistant organism to spread. A benefit to one patient can therefore alter risk for people who never receive the medicine.
Enablement
Modern medicine is full of treatments that borrow confidence from antibiotics. Transplantation, intensive chemotherapy, neonatal intensive care and complex surgery all become more precarious when infection is no longer controllable. An antimicrobial can therefore create value by allowing other medicine to proceed.
Diversity
A new agent gives clinicians another route through an evolutionary landscape. Therapeutic diversity can reduce dependence on a narrow set of drugs and can support stewardship strategies that preserve the usefulness of the wider armamentarium.
Insurance
This is perhaps the most intellectually important component. Neil Hawkins, Adrian Towse and Amanda Adler argued in 2025 that delinked payment systems can still miss part of the insurance value of antibiotics. A health system may rationally pay for protection against an uncertain but potentially disastrous future resistance scenario, just as society pays for other forms of preparedness whose value is greatest when the feared event does not occur (Hawkins et al., 2025).
Jason Gordon and colleagues explored these wider attributes specifically for ceftazidime–avibactam in the United Kingdom. Their work matters because it takes the abstract claim—“antibiotics have wider value”—and attempts to turn it into economic analysis that a payer can use (Gordon et al., 2023).
6. What the pilot actually found
The strongest temptation in policy is to call a programme successful once it has been implemented. The academic literature warns us not to do that here.
Woods and colleagues estimated substantial population value but also substantial uncertainty. Their preferred modelling produced approximately 5,400 QALYs of incremental net health effect for cefiderocol and 3,700 for ceftazidime–avibactam over 20 years. The NICE committee ultimately judged the corresponding population values to be about 16,200 and 8,800 QALYs after allowing for patient numbers and sources of value not fully captured in the quantitative models. Those higher figures were explicitly informed by committee judgement rather than by a newly precise dataset (Woods et al., 2025).
That gap between modelled and judged value is not an embarrassment. It shows the frontier of the problem. The model can count outcomes for populations we can observe. The health service must also reason about future resistance, enablement and insurance—things that are real enough to influence a decision but hard to measure with confidence.
Rebecca Glover, Andrew Singer, Adam Roberts and Claas Kirchhelle have been among the most useful critics of the UK approach. They asked whether a subscription could end up rewarding existing products without producing the genuinely novel classes and mechanisms society needs. In a subsequent Lancet Microbe commentary, Glover and colleagues challenged the language of “success” itself: a smoothly executed procurement is not the same as evidence that the antibacterial innovation ecosystem has been repaired (Glover et al., 2023a; Glover et al., 2023b).
Their challenge should be retained, not rebutted away. A public payer can prove that it knows how to buy differently long before it proves that companies will invent differently.
7. What clinicians think: the contract meets the ward
Reimbursement models are often designed in rooms far from the ward. Antimicrobial policy cannot afford that distance because a contract succeeds only if microbiologists, infectious-disease specialists and pharmacists can use the resulting medicine appropriately.
Ioannis Baltas and colleagues explored the views of infection consultants in England in the original SMASH study. The response was broadly positive: around seven in ten respondents regarded the delinked approach as welcome, and majorities thought it could improve the management of resistant infection and stimulate research and development (Baltas et al., 2023).
In February 2026, Stephen Hughes of Chelsea and Westminster NHS Foundation Trust, Ioannis Baltas of UCL Great Ormond Street Institute of Child Health and the British Society for Antimicrobial Chemotherapy, and Mark Gilchrist of Imperial College Healthcare NHS Trust and Imperial College London published a second, particularly useful view from the frontline. They surveyed lead antimicrobial stewardship pharmacists across NHS acute trusts in England.
Of the 43 pharmacists who responded, 88.4% supported the principle of the subscription model and 86.1% agreed that it could stimulate future R&D. They identified carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacterales as priorities and placed practical value on oral or once-daily intravenous administration. They also exposed an important imperfection: delinked national payment does not make local financial friction disappear. Cost remained a significant consideration for many pharmacists, and local budget and formulary realities can still affect access (Hughes et al., 2026).
This is a general lesson in market access. A national reimbursement decision can remove one barrier while leaving several others standing. “Paid for” and “easy to use in practice” are not synonyms.
8. Real-world evidence: from a contract to a learning system
If the NHS intends to pay for long-term population value, it needs a way to learn what happens after a new antimicrobial enters ordinary care. This is where the UK Antimicrobial Registry may become as important as the subscription contract itself.
Jacqueline Sneddon and colleagues introduced UKAR as a national mechanism for collecting real-world data on newer antimicrobial agents, initially with particular interest in products used for drug-resistant infection. The registry records who receives the medicines, what infections are treated, microbiology, effectiveness and safety (Sneddon et al., 2024).
By the first 20 months, UKAR had enrolled 631 participants, creating a practical evidence base around the use of recently licensed antimicrobials outside the clean boundaries of randomised trials (Sneddon et al., 2025). That matters because the patients who most need reserve antibiotics are often older, comorbid, critically ill and clinically complicated—the very population in which trial evidence can be thinnest.
Then, in April 2026, Cosmika Goswami and colleagues at the University of Strathclyde, working with partners including the University of Aberdeen and NHS Scotland, published the UKAR Virtual Registry study. By linking Scotland’s electronic prescribing data with national datasets, the team demonstrated a scalable way of monitoring utilisation, microbiology and outcomes for recently licensed antimicrobials. Their 308-patient, 353-prescription dataset is modest; the infrastructure idea is not. It points toward an automated national feedback loop in which reimbursement, stewardship and real-world outcomes can begin to speak to one another (Goswami et al., 2026).
The 2025 Woods paper had already identified the lack of nationally linked clinical, prescribing and laboratory data as a major obstacle to valuation. UKAR and UKAR:V are a direct answer to that weakness. If they mature, future decisions need not begin with quite so much darkness.
9. Europe is watching, because the UK cannot solve this alone
The British model has another limitation that no clever HTA methodology can solve: antimicrobial resistance is global, but NHS England is not.
Michael Anderson, Dimitra Panteli, Robin van Kessel, Gunnar Ljungqvist, Francesca Colombo and Elias Mossialos reviewed European incentive options in 2023. Their conclusion was not that one instrument would rescue the antibiotic pipeline. Subscription payments, market-entry rewards, transferable exclusivity mechanisms and milestone payments each have strengths and weaknesses; Europe is likely to need a portfolio of push and pull incentives, coordinated internationally and designed to preserve access as well as innovation (Anderson et al., 2023).
This matters because a £20 million annual English subscription can be meaningful without being sufficient to transform the global expected return on antibacterial R&D. The more countries reward genuine antimicrobial value in a predictable, stewardship-compatible way, the more credible the signal to investors becomes. The UK can demonstrate the mechanism. It cannot, on its own, create the entire market.
The political achievement of the NHS model may therefore be partly diplomatic. It gives other systems something concrete to examine: not a white paper about what might work, but contracts, criteria, value bands, stewardship conditions, real-world registries and an accumulating body of academic criticism.
10. What changed in 2026
By 2026 the story has moved beyond the original two-drug pilot but has not yet reached the point at which the permanent programme can be declared complete.
NHS England launched the inaugural procurement round for the permanent Antimicrobial Products Subscription Model in August 2024. NICE is responsible for convening the expert evaluation panel. On 11 June 2026, in response to a parliamentary question from Dr Danny Chambers, the Department of Health and Social Care confirmed that product assessment was still under way. Suppliers had been advised that contract awards were likely in November 2026, with contracts commencing in the first quarter of 2027 after the normal standstill period.
That timetable is important because it corrects a tempting but premature story. As of 14 August 2026, the next winners and their value bands are not yet public. The policy is active; the assessment is live; the next contracts are still ahead.
The delay should not automatically be interpreted as failure. The permanent model has moved from bespoke evaluation of two products to a repeatable procurement framework with eligibility rules, clinical criteria, points-based scoring, multiple contracting authorities and publication obligations. That is administratively harder than announcing a pilot.
Meanwhile, the clinical environment has become more demanding, not less. UKHSA’s 2026 ESPAUR report showed resistant bacteraemia rising while antibiotic stewardship targets remain in force. NHS England’s August 2026 guidance continues to require reductions in overall antibiotic exposure and a shift toward Access-category antibiotics. The national message is therefore internally consistent: conserve ordinary antibiotics better, while creating a credible market for the exceptional antimicrobial we may need when resistance defeats them.
11. Why this matters beyond antibiotics
The most interesting thing about the antimicrobial subscription model is that, in the end, it may not be principally about antibiotics. It is an experiment in paying for value that is not proportional to throughput.
Healthcare systems are excellent at buying transactions. A scan is performed. A bed-day occurs. A device is implanted. A medicine is dispensed. A tariff or price attaches to the event.
Preparedness is harder. What is an ICU bed worth on the day it remains empty? What is surge manufacturing capacity worth in the year before a pandemic? What is the value of a diagnostic platform kept ready for an outbreak that never arrives? What is the value of an antimicrobial held in reserve precisely because we are trying not to create resistance to it?
The subscription model says that utilisation is not always a sufficient proxy for value. That proposition has obvious relevance to vaccines, diagnostics, emergency countermeasures, some rare-disease platforms and other technologies whose benefits include optionality, resilience or the avoidance of downstream events.
But the antimicrobial case also offers a warning to anyone tempted to borrow the model too casually. Delinking payment from volume only makes sense when the health system can define what it is buying instead: clinical value, security of supply, stewardship, innovation, preparedness—and an evidence architecture capable of checking whether those things materialise.
12. The real test
The NHS has already proved something useful: a health service can construct a payment mechanism in which selling more antibiotics is not the route to earning more money. That is a genuine policy achievement.
It has not yet proved the larger proposition.
The larger proposition is that changing the reward will change the science that companies can afford to pursue. We should therefore judge the permanent programme against harder outcomes. Does capital return to antibacterial development? Do small biotechnology companies survive long enough to reach patients? Do programmes targeting WHO priority pathogens become investable? Do new mechanisms of action appear? Does supply become more secure? Do clinicians gain access without losing stewardship discipline? Do real-world data reduce the uncertainty that made the first NICE evaluations so laborious?
The critics are right: these questions cannot be answered by pointing to a signed contract. The advocates are also right: without a credible pull incentive, it is difficult to see why the conventional market would repair itself.
This leaves Britain in an unusually interesting position. The NHS is trying to assign a price not simply to a medicine, but to a future option: the ability to treat a patient when resistance has removed the obvious choices.
There is something almost biological about the idea. Resistance evolves because microbes respond to pressure. Markets do something similar. They respond to the incentives we create, even when the result is not the one we intended.
For decades, the antimicrobial market told companies that a medicine used sparingly was a medicine that would earn sparingly. The subscription model changes the signal. Whether industry, investors and science change with it is the experiment that matters now.
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ODELLE | HEALTH ECONOMICS & MARKET ACCESS
Academic literature
Selected peer-reviewed and foundational literature directly underpinning the argument and the UK antimicrobial subscription model.
1. Anderson, M., Panteli, D., van Kessel, R., Ljungqvist, G., Colombo, F. & Mossialos, E. (2023). Challenges and opportunities for incentivising antibiotic research and development in Europe. The Lancet Regional Health – Europe, 33, 100705. DOI: https://doi.org/10.1016/j.lanepe.2023.100705
2. Antimicrobial Resistance Collaborators (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, 399, 629–655. DOI: https://doi.org/10.1016/S0140-6736(21)02724-0
3. Baltas, I., Gilchrist, M., Koutoumanou, E. et al. (2023). Exploring the views of infection consultants in England on a novel delinked funding model for antimicrobials: the SMASH study. JAC-Antimicrobial Resistance, 5(4), dlad091. DOI: https://doi.org/10.1093/jacamr/dlad091
4. Barlow, E., Morton, A., Megiddo, I. & Colson, A. (2022). Optimal subscription models to pay for antibiotics. Social Science & Medicine, 298, 114818. DOI: https://doi.org/10.1016/j.socscimed.2022.114818
5. Brassel, S., Al Taie, A. & Steuten, L. (2023). Value assessment of antimicrobials using the STEDI framework – How steady is the outcome? Health Policy, 136, 104892. DOI: https://doi.org/10.1016/j.healthpol.2023.104892
6. GBD 2021 Antimicrobial Resistance Collaborators (2024). Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. The Lancet, 404(10459), 1199–1226. DOI: https://doi.org/10.1016/S0140-6736(24)01867-1
7. Glover, R.E., Singer, A.C., Roberts, A.P. & Kirchhelle, C. (2023a). The antibiotic subscription model: fostering innovation or repackaging old drugs? The Lancet Microbe, 4(1), e2–e3. DOI: https://doi.org/10.1016/S2666-5247(22)00235-X
8. Glover, R.E. et al. (2023b). Why is the UK subscription model for antibiotics considered “successful”? The Lancet Microbe. DOI: https://doi.org/10.1016/S2666-5247(23)00250-1
9. Gordon, J., Gheorghe, M., Goldenberg, S., Miller, R., Dennis, J. & Al-Taie, A. (2023). Capturing Value Attributes in the Economic Evaluation of Ceftazidime with Avibactam for Treating Severe Aerobic Gram-Negative Bacterial Infections in the United Kingdom. PharmacoEconomics, 41, 1657–1673. DOI: https://doi.org/10.1007/s40273-023-01310-6
10. Goswami, C., Turgal, E., Mueller, T., Bennie, M. et al. (2026). UK Antimicrobial Registry: Virtual Registry—an innovative surveillance approach for monitoring the real-world use and effectiveness of newly licensed antimicrobials in Scotland. JAC-Antimicrobial Resistance, 8(2), dlag053. DOI: https://doi.org/10.1093/jacamr/dlag053
11. Hawkins, N., Towse, A. & Adler, A. (2025). Missing Pieces of the Puzzle to Address Market Failures for Antibiotics: Delinked Payment Systems and Insurance Value. PharmacoEconomics – Open, 9(5), 707–712. DOI: https://doi.org/10.1007/s41669-025-00591-1
12. Hughes, S., Baltas, I. & Gilchrist, M. (2026). Exploring the perspectives of antimicrobial stewardship pharmacists in England on the subscription model for antimicrobial drugs. JAC-Antimicrobial Resistance, 8(1), dlag018. DOI: https://doi.org/10.1093/jacamr/dlag018
13. Leonard, C., Crabb, N., Glover, D., Cooper, S., Bouvy, J., Wobbe, M. & Perkins, M. (2023). Can the UK “Netflix” Payment Model Boost the Antibacterial Pipeline? Applied Health Economics and Health Policy, 21(3), 365–372. DOI: https://doi.org/10.1007/s40258-022-00786-1
14. Outterson, K. & Rex, J.H. (2023). Global Pull Incentives for Better Antibacterials: The UK Leads the Way. Applied Health Economics and Health Policy, 21(3), 361–364. DOI: https://doi.org/10.1007/s40258-023-00793-w
15. Rothery, C., Woods, B., Schmitt, L., Claxton, K., Palmer, S. & Sculpher, M. (2018). Framework for value assessment of new antimicrobials: implications of alternative funding arrangements for NICE appraisal. EEPRU Research Report 059, Universities of Sheffield and York. DOI: https://doi.org/10.15131/shef.data.25219094
16. Sneddon, J., Macfarlane, G.J., Jones, G.T. et al. (2024). Introducing the UK Antimicrobial Registry (UKAR) study: providing real world data on new antimicrobials to support antimicrobial stewardship and tackle antimicrobial resistance. JAC-Antimicrobial Resistance, 6(4), dlae107. DOI: https://doi.org/10.1093/jacamr/dlae107
17. Sneddon, J. et al. (2025). The UK Antimicrobial Registry (UKAR): an overview of the first 20 months of recruitment. JAC-Antimicrobial Resistance, 7(6), dlaf242. DOI: https://doi.org/10.1093/jacamr/dlaf242
18. Woods, B., Kearns, B., Schmitt, L., Jankovic, D., Rothery, C., Harnan, S., Hamilton, J., Scope, A., Ren, S., Bojke, L., Wilcox, M., Hope, W., Leonard, C., Howard, P., Jenkins, D., Ashworth, A., Bentley, A. & Sculpher, M. (2025). Assessing the Value of New Antimicrobials: Evaluations of Cefiderocol and Ceftazidime-Avibactam to Inform Delinked Payments by the NHS in England. Applied Health Economics and Health Policy, 23(1), 5–17. DOI: https://doi.org/10.1007/s40258-024-00924-x
NHS, NICE, government and industry sources
O1. NHS England (2024). Antimicrobial products subscription model: guidance on commercial arrangements. Link: https://www.england.nhs.uk/long-read/antimicrobial-products-subscription-model-guidance-on-commercial-arrangements/
O2. NHS England (2024). Antimicrobial Products Subscription Model: publication page and inaugural procurement information. Link: https://www.england.nhs.uk/publication/antimicrobial-products-subscription-model-guidance-on-commercial-arrangements/
O3. NICE. A new model for evaluating and purchasing antimicrobials in the UK. Link: https://www.nice.org.uk/what-nice-does/life-sciences-how-to-get-your-product-to-market/a-new-model-for-evaluating-and-purchasing-antimicrobials-in-the-uk
O4. Department of Health and Social Care and UK administrations (2024). Confronting antimicrobial resistance 2024 to 2029: UK five-year national action plan. Link: https://www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2024-to-2029/confronting-antimicrobial-resistance-2024-to-2029
O5. UK Health Security Agency (2026). ESPAUR report 2024 to 2025: extended summary. Link: https://www.gov.uk/government/publications/english-surveillance-programme-for-antimicrobial-utilisation-and-resistance-espaur-2024-to-2025-report/espaur-report-2024-to-2025-extended-summary
O6. NHS England (2026). Guidance on delivery of the antimicrobial prescribing targets of the UK AMR National Action Plan. Link: https://www.england.nhs.uk/long-read/guidance-on-delivery-of-the-antimicrobial-prescribing-targets-of-the-uk-amr-national-action-plan/
O7. UK Government (2025). UK 2024 to 2029 antimicrobial resistance national action plan: one-year progress report. Link: https://www.gov.uk/government/publications/uk-5-year-action-plan-for-amr-1-year-progress-report/uk-2024-to-2029-antimicrobial-resistance-national-action-plan-1-year-progress-report
O8. UK Parliament (2026). Written Question 7918: timetable for the UK antimicrobial subscription model. Answered 11 June 2026. Link: https://questions-statements.parliament.uk/written-questions/detail/2026-06-08/7918/
O9. Find a Tender Service (2026). Evaluation of antibiotic products for antimicrobial subscription model. Link: https://www.find-tender.service.gov.uk/procurement/ocds-h6vhtk-06b0c9
O10. Shionogi (2022). Shionogi signs agreement with NHS England for cefiderocol under subscription-style reimbursement model. Link: https://www.shionogi.com/global/en/news/2022/06/20220616.html
O11. Pfizer (2022). Breakthroughs in the fight against antimicrobial resistance: UK subscription-type payment model. Link: https://www.pfizer.com/sites/default/files/investors/financial_reports/annual_reports/2022/story/breakthroughs-in-the-fight-against-antimicrobial-resistance/
O12. British Society for Antimicrobial Chemotherapy. UK Antimicrobial Registry (UKAR). Link: https://bsac-ukar.org/