Assessing the Value of New Antimicrobials: Evaluations of Cefiderocol and Ceftazidime-Avibactam to Inform Delinked Payments by the NHS in England

Beth Woods (), Ben Kearns, Laetitia Schmitt, Dina Jankovic, Claire Rothery, Sue Harnan, Jean Hamilton, Alison Scope, Shijie Ren, Laura Bojke, Mark Wilcox, William Hope, Colm Leonard, Philip Howard, David Jenkins, Alan Ashworth, Andrew Bentley and Mark Sculpher
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Beth Woods: University of York
Ben Kearns: University of Sheffield
Laetitia Schmitt: University of York
Dina Jankovic: University of York
Claire Rothery: University of York
Sue Harnan: University of Sheffield
Jean Hamilton: University of Sheffield
Alison Scope: University of Sheffield
Shijie Ren: University of Sheffield
Laura Bojke: University of York
Mark Wilcox: University of Leeds and Leeds Teaching Hospitals
William Hope: University of Liverpool
Colm Leonard: Manchester University NHS Foundation Trust, Wythenshawe Hospital
Philip Howard: University of Leeds
David Jenkins: University Hospitals of Leicester NHS Trust
Alan Ashworth: Manchester University NHS Foundation Trust
Andrew Bentley: University of Manchester NHS Foundation Trust
Mark Sculpher: University of York

Applied Health Economics and Health Policy, 2025, vol. 23, issue 1, No 2, 5-17

Abstract: Abstract Objectives The UK has recently established subscription-payment agreements for two antimicrobials: cefiderocol and ceftazidime-avibactam. This article summarises the novel value assessments that informed this process and lessons learned for future pricing and funding decisions. Methods The evaluations used decision modelling to predict population incremental net health effects (INHEs), informed by systematic reviews, evidence syntheses, national surveillance data and structured expert elicitation. Results Significant challenges faced during the development of the evaluations led to profound uncertainty in the estimates of INHEs. The value assessment required definition of the population expected to receive the new antimicrobials; estimating value within this heterogenous population; assessing comparative efficacy using antimicrobial susceptibility data due to the absence of relevant clinical data; and predicting population-level benefits despite poor data on current numbers of drug-resistant infections and uncertainties around emerging resistance. Though both antimicrobials offer the potential to treat multi-drug resistant infections, the benefits estimated were modest due to the rarity of true pan-resistance, low life expectancy of the patient population and difficulty of identifying and quantifying additional sources of value. Conclusions Assessing the population INHEs of new antimicrobials was complex and resource intensive. Future evaluations should continue to assemble evidence relating to areas of expected usage, patient numbers over time and comparative effectiveness and safety. Projections of patient numbers could be greatly enhanced by the development of national level linked clinical, prescribing and laboratory data. A practical approach to synthesising these data would be to combine expert assessments of key parameters with a simple generic decision model.

Date: 2025
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DOI: 10.1007/s40258-024-00924-x

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