Moves towards paying for medicines according to patient outcomes are taking off in the US and Europe, with healthcare systems and the pharma industry broadly agreeing this approach is the future.
However there remains lots of barriers to make outcome-based payment (OBP) a mainstream approach.
This includes questions about how to make these mechanisms fair by balancing rewards for innovation with giving healthcare systems value for money, and finding novel ways to pay for very high cost drugs which could potentially cure patients.
Also of central importance is the need to build robust data collection and real world evidence systems.
Now England’s leading devolved health region, Greater Manchester, has teamed up with charity Cancer Research UK to look at how to adopt the new approach.
Cancer Research UK and the Greater Manchester Health and Social Care Partnership have commissioned researchers to consult experts in government, NHS England, NICE, the pharmaceutical industry, as well as people affected by cancer.
The aim of this research was to develop agreement on the treatment outcomes that should form the basis of an OBP approach.
Based on feedback from patients and their families about what treatment results are most important to them, the report recommends that when any OBP scheme is introduced it should link the drug’s price to its impact on survival, disease progression or relapse, long-term side effects, and return to normal life.
The big challenge in realising this vision is having a nationwide digital system to collect all the relevant clinical data.
England’s cancer data infrastructure can already capture information about what medicines patients are receiving and how they are responding, but the quality of this data and coverage across the country has been patchy until now.
Cancer Research UK and the GMHSC Partnership have now pledged to do further work looking at the feasibility of delivering OBP in practice, including whether improvements to the data captured on patients’ outcomes are needed.
Emlyn Samuel, Cancer Research UK’s head of policy development, said: “Ensuring cutting-edge medicines reach patients as quickly as possible is vital if we’re to achieve our ambition of three in four patients surviving their cancer by 2034.
“The NHS long-term plan committed to getting innovative technologies to patients quicker to improve outcomes. While the UK is already among the top countries in the world in making new cancer medicines available to patients, it’s vital for patients and their families that we continue to lead the way.
“Outcome-based payment is a promising way to get some drugs to patients quickly where the NHS and the manufacturer are struggling to agree a fixed price. This is already happening in other disease areas like hepatitis C and multiple sclerosis. We look forward to working with government, NHS England, industry and patients to make this approach an option for new cancer drugs too.”
Greater Manchester’s Dr Richard Preece
Dr Richard Preece, medical director and executive lead for Greater Manchester Health and Social Care Partnership, and chair of the Greater Manchester Cancer Board said:
“Our aim is to make sure that the billion pounds we invest in medicines is well spent to ensure the greatest, fastest improvement to the health and wellbeing of everyone who lives in Greater Manchester.
“Partnering with Cancer Research UK is a phenomenal opportunity to continue working towards reducing the use of medicines that are not giving people the benefits they need, ensuring that patients are able to access new and innovative medicines as early as possible and delivering better value for money.”
As well many new outcomes-based deals being agreed between the industry and new regional authorities like Greater Manchester, there is already national deals. These include the use of Cancer Drugs Fund ‘managed access scheme’ as well as bespoke outcomes-based deals agreed between NHS England and companies such as Merck for its MS drug Mavenclad, and a ‘pay by cure’ deal for hepatitis C treatments.
One company which has launched its own UK-specific outcomes guarantee deal with local NHS organisations is Novartis, for its psoriasis treatment Cosentyx.
Commenting on the report, Andrew Miniuks, value and access manager at the Association of the British Pharmaceutical Industry (ABPI) said:
“Outcome-based pricing could help the NHS get better value from new medicines and help our members better understand how treatments are changing patient’s lives.
“We’re set to see more personalised medicines being launched over the next few years, so additional data will help ensure those treatments are being targeted at the patients most likely to benefit, and also help identify areas for further R&D investment.”