Can the UK 'Netflix' Payment Model Boost the Antibacterial Pipeline?

The silent pandemic of antimicrobial resistance (AMR) is a global issue needing prompt attention. A comprehensive one-health approach across human and animal health, agriculture and the environment is needed to solve this, addressing overuse of antibacterials, and of course, optimising measures for preventing and controlling infection. We also need a robust pipeline of new antibacterials. However, the current pipeline is inadequate and several companies with new antibacterials have gone bankrupt due to low sales, leading to a 'broken market'. To address this, the UK has completed a project using novel approaches to value assessment and reimbursement for two antibacterials. The new funding arrangements for these products commenced on 1st July 2022, delinking reimbursement from volume of sales; a so-called 'pull incentive', with payments based on the added value to the whole-health and social-care system, not just to individual patients. This article describes how the project was devised, developed, and progressed. The learning from this work might help other countries to adopt or adapt the approach to fit with their national systems, and collectively achieve a global incentive to reinvigorate the antibacterial pipeline.