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It Takes 2 to Tango. Setting Out the Conditions in Which Performance-Based Risk-Sharing Arrangements Work for Both

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  • 1Senior Visiting Fellow, Office of Health Economics, London, UK.

Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
|April 14, 2024
PubMed
Summary
This summary is machine-generated.

Performance-based risk-sharing arrangements can improve patient access to innovative treatments by addressing payer uncertainty about product value. This approach resolves disagreements between innovators and payers, benefiting both parties.

Keywords:
accelerated approvalcoverage with evidence developmentrisk sharinguncertaintyvalue of information

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Area of Science:

  • Health Economics
  • Health Technology Assessment
  • Pharmaceutical Policy

Background:

  • Accelerated approval pathways aim to speed patient access but often face payer uncertainty regarding cost-effectiveness and value.
  • Performance-based risk-sharing arrangements (RSRAs) offer a mechanism to manage uncertainty between innovators and payers.
  • Existing literature lacks a formal framework for applying RSRAs to address differing expectations about product value.

Purpose of the Study:

  • To explore the potential of RSRAs to bridge the gap between innovator and payer perspectives on product value and cost-effectiveness.
  • To develop a framework for identifying circumstances where RSRAs can enhance reimbursement schemes for products approved via accelerated pathways.
  • To analyze the conditions under which RSRAs create value for both pharmaceutical innovators and healthcare payers.

Main Methods:

  • Utilized a value of information framework to model payer and innovator perspectives on cost-effectiveness and research value.
  • Developed 5 analytical rules to evaluate 16 distinct scenarios of payer and innovator expectations.
  • Assessed the impact of factors such as research funding and administrative costs on the viability of RSRAs.

Main Results:

  • Risk-sharing arrangements were found to provide an improved solution in 9 out of 16 analyzed scenarios.
  • The study identified specific combinations of payer and innovator expectations where RSRAs are most beneficial.
  • The allocation of research and administrative costs significantly influences the effectiveness of risk-sharing agreements.

Conclusions:

  • RSRAs can effectively address payer uncertainty and facilitate earlier patient access to innovative treatments.
  • Implementation requires practical steps to ensure payer adoption, potentially involving innovator-borne costs aligned with global market incentives.
  • Successful RSRAs offer benefits such as improved health system efficiency, confident payer spending, and enhanced innovator returns.