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Information on how to access prescribing information and adverse event reporting can be found towards the bottom of the page.

Antimicrobial Subscription
Model Pilot

Zavicefta (ceftazidime-avibactam) is one of two antimicrobial products to be selected for NICE technology appraisal and guidance, as part of a novel pilot announced by the Secretary of State for Health and Social Care in the UK 5-year national action plan1 on antimicrobial resistance (AMR).

The NICE antimicrobial health technology evaluation guidance applies to England (but not Scotland, Wales or Northern Ireland) and recommends that Zavicefta should be used appropriately, within its marketing authorisation, as an option for treating severe drug-resistant infections caused by Gram-negative bacteria.2

Zavicefta Indication

Zavicefta is indicated in adults and paediatric patients aged 3 months and older for the treatment of the following infections:

  • Complicated intra-abdominal infection (cIAI)
  • Complicated urinary tract infection (cUTI), including pyelonephritis 
  • Hospital-acquired pneumonia (HAP), including ventilator associated pneumonia (VAP)

Treatment of adult patients with bacteraemia that occurs in association with, or is suspected to be associated with, any of the infections listed above.
Zavicefta is also indicated for the treatment of infections due to aerobic Gram-negative organisms in adults and paediatric patients aged 3 months and older with limited treatment options. Consideration should be given to official guidance on the appropriate use of antibacterial agents.

The objective of the antimicrobial subscripton pilot

A challenging R&D landscape

The market potential for new antibiotics is limited, due to the steep costs of antimicrobial development, high risk of failure, long lead times, and growing awareness of the need to limit their use.7

No novel class of antibiotic has been discovered for almost 40 years. There are a limited number of antibiotics in clinical development at present, while thousands of potential immuno-oncology therapies are currently being evaluated. The rate of innovation is insufficient to meet current and future needs.8

Challenging economic hurdles mean there are few incentives for venture capital or pharmaceutical companies to invest in antibiotic R&D since it will be difficult to realize a sufficient return. Three antibiotic developers filed for bankruptcy in 2019 alone.9–11

AMR is a significant economic burden, causing an estimated €1.1 billion annual cost to healthcare systems in Europe.12

Pfizer has partnered with NHS England, NICE and the UK government to pilot a world-first innovative reimbursement model for antimicrobials. This initiative is a first step in assessing the broader value that antibiotics bring to people and society . Under this model, NHSE will  reimburse the supplier centrally using a subscription-style payment contract that pays a fixed annual fee irrespective of the volumes used by the NHS. This “top-up” is intended to align the financial incentives for the respective pharmaceutical companies and reward companies for bringing new antimicrobial products to market even when the volumes used are low, especially in the years immediately following launch. The intention of this initiative is to start to reinvigorate investment in antibiotics; however other countries would also need to develop and implement initiatives to make this work on a global level.

To find out more about this global issue and what can be done about it listen to this New Statesman podcastListen nowLoading


Local commissioners remain the lead commissioners in line with policy for all antibiotics, and hospital pharmacies should continue to order packs of Zavicefta in the normal way through their procurement systems and pay per pack as they purchase the product.

While funding to NHS Trusts for Zavicefta will continue to be through the relevant Payment by Results (PbR) tariffs and will not require any prior approval, NHS England has made the completion of a Blueteq form a policy requirement. The forms are being used to monitor the use of Zavicefta in a similar approach to that used to monitor the use of COVID-19 treatments.


Zavicefta Subscription Model: Product & Payment Flow Model

  1. Hospital pharmacies should continue to order packs of Zavicefta through normal processes via suppliers (i.e. Alliance Healthcare) and they will continue to receive product through our direct to pharmacy (DTP) distribution model.
  2. Hospitals will continue to be invoiced for their orders in the same way as before the pilot.
  3. NHS England have agreed a confidential invoice pack price that is lower than the list price. The lower price will be applied on invoice from 1st July 2022.
  4. Hospitals should continue to pay for these packs on current payment terms.
  5. Payments to NHS Trusts for Zavicefta will continue to be through the relevant Payment by Results (PbR) tariffs and will not require any prior approval before use.
  6. Quarterly contract payment (25%) direct from NHSE, less the value of the purchases made in that quarter (no. of packs x invoice price) (5 on diagram)

Drug Usage Monitoring13,14:
 

A drug usage monitoring form13 (Blueteq form) has been implemented as part of this model. Whilst prior approval is not required for the use of ceftazidime-avibactam, it remains important that prescribing continues to adhere to good stewardship to reduce the risk of resistance developing. The form is designed to capture data on the organism of concern, the suspected resistance mechanism, additional therapy, and site of infection.

It is recognised that this adds administration burden to front line staff but as requested by NHSE, you are encouraged to complete the form to collect the required data as it will help assess and monitor the success of this novel reimbursement model and to understand the types of infections it is being used to treat. 

It is important to confirm patient eligibility and should include the use of diagnostic testing to confirm the susceptibility of the pathogen to the agents.

The Journey of a Sample: Diagnostic Testing in the Treatment of Bacterial Infections

Explore more​​​​​​​

Patient Risk Factors

Identifying patients at risk of MDR Gram-negative infections is vital for appropriate selection of adequate, early antimicrobial therapy to reduce the risk of fatal outcomes15.

 

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Antimicrobial Stewardship

Access our resources for implementation of an Antimicrobial Stewardship Programme and learn more about Pfizer initiatives to fight AMR


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Prescribing information

Click here for Zavicefta ® (ceftazidime-avibactam)

References

https://www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2019-to-2024 Last accessed March 2023https://www.nice.org.uk/about/what-we-do/life-sciences/scientific-advice/models-for-the-evaluation-and-purchase-of-antimicrobials/ceftazidime-with-avibactam. Last accessed March 2023ZAVICEFTA. Summary of Product CharacteristicsLiscio JL, et al. Int J Antimicrob Agents 2015;46:266–71Nicolau DP, et al. J Antimicrob Chemother 2015;70:2862–9Mazuski JE, et al. Surg Infect 2017;18:1–76Wellcome. Why is it so hard to develop new antibiotics? January 2020. Available at: https://wellcome.org/news/why-is-it-so-hard-develop-new-antibiotics Last accessed March 2023Pew Charitable Trusts. (2021). Tracking the Global Pipeline of Antibiotics in Development. Available at: https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/tracking-the-global-pipeline-of-antibiotics-in-development. Last accessed March 2023.Taylor, P. (2019). “End of the line looms for Aradigm as it files for bankruptcy”. FierceBiotech. Published 19 February 2019. Available at: https://www.fiercebiotech.com/biotech/end-line-looms-for-aradigm-as-it-files-for-bankruptcy Last accessed March 2023Mullard, A. (2019). Achaogen bankruptcy highlights antibacterial development woes. Nature Reviews Drug Discovery, 18(6):411.Taylor, N.P. (2020). “Melinta files for bankruptcy in another dark day for antibiotics”. FierceBiotech. Published 2 January 2020. Available at: https://www.fiercebiotech.com/biotech/melinta-files-for-bankruptcy-another-dark-day-for-antibiotics Last accessed March 2023OECD. Antimicrobial Resistance: Tackling the Burden in the European Union. 2019. Available at: https://www.oecd.org/health/health-systems/AMR-Tackling-the-Burden-in-the-EU-OECD-ECDC-Briefing-Note-2019.pdf Last accessed March 2023CavAzi01_ver1.0drug usage monitoring form Ceftazidimeavibactam for treating severe drug-resistant Gram-negativebacterial infectionSSC2392 - Provider_Letter_ceftazidime-avaibactam_and_cefdericol V1.0Bonine NG, et al. Am J Med Sci 2019;357:102–10.
PP-ZVA-GBR-1759. April 2023.
Access case studies and videosPathogen CoveragePathogen Coverage

ZAVICEFTA has broad spectrum coverage against Gram-negative pathogens including in vitro activity against MDR P.aeruginosa, CRE, including KPC- and OXA-48 producing strains, and ESBL- and AmpC-producing bacteria3-6.

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Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search 

for MHRA Yellow Card in Google Play or Apple App Store

 

Adverse events should also be reported to Pfizer Medical Information on 01304 616161

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