Making Outcome-Based Payment for Cancer Medicines a Reality in the NHS


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Amanda Cole1,Patricia Cubi-Molla1,Jack Pollard2,Duncan Sim3,Richard Sullivan4,Jon Sussex2,Paula Lorgelly4
1Office of Health Economics, London, UK,2RAND Europe, Cambridge, UK,3Cancer Research UK, London, UK,4King's College London, London, UK

Abstract

Background

Many cancer medicines are made available on the NHS based on a price discount agreed between the NHS and the manufacturer. However, uncertainty in the evidence base and associated value proposition can prolong price negotiation and risk delaying patient access. More flexible ways for the NHS to pay for medicines, such as Outcome-Based Payment (OBP), which links a medicine’s price to NHS patients’ treatment outcomes, could provide a solution. Cancer Research UK and Greater Manchester Health and Social Care Partnership commissioned the Office of Health Economics, RAND Europe, and King’s College London to explore the feasibility of introducing an OBP approach for new cancer drugs in England.

Method

  • Literature reviews of patient outcome metrics and existing payment schemes linking outcomes with pricing;
  • Interviews with NHS and government stakeholders, healthcare professionals, and pharmaceutical industry representatives;
  • Focus groups and survey with people affected by cancer;
  • Preliminary review of NHS Health and Cancer data.

Results

Implementation of OBP in the NHS is possible and desirable for some new cancer medicines and is most relevant where substantial uncertainty remains about the effectiveness of a medicine based on clinical trial data. There is no single ‘best buy’ OBP scheme to apply generally. Variation in schemes will be contingent upon factors such as cancer site and stage, patient demographics and the nature of the evidence uncertainty. Future OBP schemes in the NHS should include both clinical and quality-of-life patient outcome measures: survival; disease progression, relapse or recurrence; long-term side effects; and return to normal activities. Issues around real-world data present key barriers to implementing OBP in the NHS.

Conclusion

Significant advances in understanding the principles based on which an OBP approach might be used for new cancer medicines for the NHS in England have been achieved. Future research will establish the necessary steps for implementing a pilot OBP scheme.