Outcome-based payment for cancer drugs – How to reap the benefits?

Cancer Research UK and Greater Manchester Health and Social Care Partnership (GMHSCP) recently published their latest research into outcome-based payment (OBP): Making Outcome-Based Payment a Reality in the NHS (cancerresearchuk.org) 

Back in 2019, they argued that OBP would be beneficial for cancer drugs, identifying four key outcomes that should be used as performance measures: 

• Survival  
• Disease progression, recurrence of relapse
• Long-term side effects  
• Return to normal activities  

Their November 2021 report looks at practical considerations, flagging the last two outcomes as those where data capture currently poses the biggest challenge.  

So far, so good.  

The report goes on to recommend that payment be linked to benefits for individual patients, rather than average outcomes across populations. It also suggests that NHS payments should be subject to a rebate where outcomes are not as successful as expected.   

Which is where it gets a little more tricky...

How do we agree on expected levels of success?

Demonstrating tangible benefits for real patients is what we all want to see, but every patient is unique. If the NHS does adopt a rebate scheme, who is best placed to decide what constitutes success and, just as importantly, measure it?   

To go a step further, the cynical among us might ask in whose interests is it to collect the data?  

Obviously, the patients are the intended beneficiaries, but in the first case it is primarily to the advantage of the NHS. We know data collection requires effort and resources, but could this burden be transferred by tweaking the model? 

Should the NHS seek to reduce up-front costs, by introducing a quality payment based on agreed outcomes data captured by pharma? The incentive to industry is clear and the established use of Patient Support Programmes (PSPs) by pharma companies provides both an example, and potentially a mechanism, for doing it.  

The NHS Confederation identified the benefits of PSPs in a briefing paper of 2018, rightly highlighting their potential to reduce costs and drive up outcomes: FINAL NHS Confederation BRIEFING 309 The value of patient support programmes_4.pdf The added attraction of minimal management overheads to the NHS is obvious.  

Risk sharing and value-based contracting are nothing new. Over the past few years we have seen a blizzard of acronyms attempt to define such schemes. From PbR BPTs to CED via MEAs.

(For the uninitiated - Payment by Results Best Practice Tariffs, Coverage with Evidence Development and Managed Entry Agreements). 

The key is always creating defined expectations with clear incentives.  

Cancer Research UK & GMHSCP are looking at undertaking stakeholder engagement to examine OBP implementation. Defining outcome measures will no doubt form a major part of the process. It will be interesting to see if there is any ‘rebate vs top-up’ discussion, and where consensus lies.