Location: Catalonia, Spain.

Work area: Products, Policy, Process.

Summary: The Catalan Region makes use of Pre-Commercial Procurement procedures to research and develop innovative solutions that contribute to societal unmet needs like Antimicrobial resistance (AMR)

This case study was first published in the report Strategic procurement in European healthcare, produced by Health Care Without Harm Europe.

Initial situation

In the EU, it is estimated that AMR is responsible for 33,000 deaths a year, and a loss of over €1.5 billion to the economy i.e. healthcare costs and productivity losses^{1, 2}.

Hospitals are considered hotspots for the development and spread of drug-resistant bacteria, with approximately 75% of drug-resistant bacteria associated with healthcare³.

Proposed alternatives

AQuAS, in a consortium with six procuring authorities⁴, launched the Anti-SUPERBugs pre-commercial procurement project (PCP) to develop active surveillance systems and contribute to the reduction of Multi-drug resistant organisms⁵. They support and finance the development of a smart ICT solution that will:

• Improve the quality of care processes in hospitals.
• Reduce both the healthcare & governmental costs and the operational impact resulting from infections caused by MDROs.
• Improve the appropriateness and effectiveness of antimicrobial medicine usage.

Reduce the community and social care impact of MDROs acquired in hospitals through the procurement of pre‐commercial technologies that will transform current Surveillance and Infections control systems into new comprehensive systems.

Progress and benefits

The project (not yet concluded) has progressed as follows:

1. Business case and criteria prioritisation: Each procuring authority had to identify common requirements, business cases, and criteria for a solution that would reduce costs by 10%. The outcome of this step was a ‘wish-list’ with the procurement requirements and available budget to develop the technology.
2. Market research: The technology expert analysed advanced, state of the art technologies available, technology surveillance, and validation of the technological solution.
3. Open market consultation: The consortium organised consultations in each of the project countries in both local language and English to involve as many companies as possible, including SMEs. Suppliers provided feedback on the feasibility of the procurement demand, but there was no need to readjust the initial list of criteria.
4. Definition of the rules and regulation that would be implemented in the project Request for Tenders (RfT) document, which included the description of the tendering procedure, the expected results, the contracting approach and the budget distribution between phases.

Tender publication: Suppliers were given three months to submit their bid; the tender closed on 28 October 2019 and four suppliers were awarded with a framework Agreement and the Phase 1 contract.

Implementation process

Despite all partners agreeing about the need for that type of technology, it was difficult to secure R&D funding from the public and not-for profit entities involved, due to the inherent risks of R&D activities, no guarantee of success are offered to the public entities investing in innovation. Taking such financial risks with public funds is a difficult path to take in public procurement. To overcome this, each hospital involved prepared a business case from a demand and cost perspective, analysing their organisational costs caused by Hospital Acquired Infections (HAIs) e.g. longer hospital stays or increased use of antibiotics. They also considered the potential savings of using this new technology e.g. early detection helps to identify the correct amount of the most appropriate drugs.

It is important to have as many suppliers as possible in the process to create competition and avoid a ‘locked-in’ situation. Procurers should foresee regular interaction with selected contractors throughout the whole process and give feedback on the innovation.

Next steps

The next steps of the project are:

1. Evaluation and selection of the offers based on their innovative approach and on the demonstration that they have the technical and financial solvency to carry forward the project and ensure its sustainability beyond the PCP.
2. Solution Design: The four shortlisted companies will have three months to design a business plan to develop the innovation; three companies will be selected based on the quality of their work plan.
3. Prototyping: The three selected companies will receive funding to prototype and test the technology over a period of six months.

Proof of concept and solution test: Two companies will have the opportunity to test their prototypes in three of the participating hospitals for a period of nine months.

Information about the organization

The Catalan Agency for Health Information, Assessment and Quality (AQuAS) - a public agency of the Catalan Health Ministry - is responsible for health technology assessment, health care evaluation services, and managing calls for research. Its mission is to generate knowledge that contributes to improved quality, safety, and sustainability of the Catalan Healthcare System and thus easing the decision-making process for citizens and healthcare managers and professionals.

1. European Commission (2019). EU Action on Antimicrobial Resistance. ec.europa.eu/health/amr/antimicrobial-resistance_en

2. European Commission, Digital Single Market (2018). Policy: Pre-Commercial Procurement. ec.europa.eu/digital-single-market/en/pre-commercial-procurement [Last accessed 20/11/2019].

3. Cassini, A. et al. (2019). Attributable deaths and disability-adjusted life-years caused by infectious with antibiotic-resistant bacteria in the EU and the EEA in 2015: A population-level modelling analysis. The lancet Infectious Diseases, Volume 19, Issue 1, pp. 56-66. www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30605-4/fulltext

4. Namely Institut Català d’Ocologia, Provincia Autonoma di Trento, HELIOS Klinikum Wuppertal, Fundació Mutua de Terrassa, Sheffield Teaching Hospitals and Universitaetklinikum Aachen. As project coordinator, AQuAS acts as a procuring entity on behalf of these other six procuring authorities; to deliver the project, they collaborate with a EU expert on innovation procurement, Sara Bedin, and RISE Research Institutes of Sweden (technology expert in the field).

5. Pre-Commercial Procurement (PCP) is a tool that public authorities can use to stimulate innovation and the development of solutions for unmet needs.