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Identifying Outcome Measures for Type 2 Diabetes Value-Based Contracting Using the Delphi Method.

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Value-based contracts for diabetes medications should prioritize reducing heart attack risk and A1c levels. These measures are most meaningful to patients and physicians, ensuring effective shared risk agreements.

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Area of Science:

  • Health Economics
  • Pharmaceutical Policy
  • Clinical Outcomes Research

Background:

  • Value-based contracts (VBCs) link drug payments to performance, requiring shared risk between payers and manufacturers.
  • Previous VBCs often used surrogate endpoints, potentially not aligning with patient priorities.
  • Identifying patient-centered outcome measures is crucial for effective VBCs in diabetes management.

Purpose of the Study:

  • To determine meaningful and measurable outcome metrics for diabetes medications within VBCs.
  • To inform the selection of performance measures that resonate with key stakeholders.

Main Methods:

  • A modified Delphi survey involved diverse stakeholders: patients, physicians, payers, and pharmaceutical representatives.
  • Participants rated the importance and feasibility of 12 diabetes-related outcomes using Likert scales.
  • Consensus was defined as >=75% agreement; statistical tests compared patient and non-patient preferences.

Main Results:

  • All 12 outcomes achieved consensus for importance.
  • "Reducing risk of heart attacks" was the most meaningful outcome (84%), followed by "reducing A1c levels" (68%).
  • "Reducing A1c levels" and "reducing risk of hospitalizations from diabetes" were most feasible (93.8% each). Significant differences emerged in prioritizing kidney disease risk reduction.

Conclusions:

  • "Reducing risk of heart attacks" and "reducing A1c levels" are top-priority outcome measures for diabetes VBCs.
  • Stakeholder input is vital for selecting relevant and feasible measures in VBC design.
  • Aligning VBCs with patient-valued outcomes can enhance their effectiveness and impact.