Outcome-Based Payment Schemes: What Outcomes Do Patients with Cancer Value?

Area of Science:

• Oncology
• Health Economics
• Patient-Reported Outcomes

Background:

• Reimbursement decisions for new cancer medicines are influenced by cost-effectiveness, potentially delaying patient access.
• Outcome-based payment (OBP) schemes link drug pricing to real-world patient outcomes to accelerate access.
• Current OBP schemes often prioritize clinical outcomes, with uncertainty regarding their alignment with patient-valued outcomes.

Purpose of the Study:

• To identify and prioritize patient-valued outcomes for cancer that can inform the development of practical OBP schemes.
• To establish a foundation for OBP schemes that better reflect patient priorities in cancer care.

Main Methods:

• Literature review to identify potential patient outcomes in cancer care.
• Two focus groups with cancer patients to evaluate and refine the list of outcomes.
• An online survey of patients and carers to rank the importance of shortlisted outcomes.

Main Results:

• Focus groups identified key clinical and functional outcomes important to patients.
• Survey analysis of 164 responses revealed the top four outcomes: survival, progression/relapse/recurrence, post-treatment side effects, and return to normal daily activities.
• Patients and carers ranked these four outcomes as most significant.

Conclusions:

• Commissioners should prioritize data collection on survival, progression, side effects, and return to daily activities for OBP schemes.
• Current data collection within the National Health Service (NHS) primarily includes mortality, with challenges in linking progression and morbidity data for OBP.
• Aligning OBP schemes with patient-valued outcomes is crucial for improving access to novel cancer therapies.