Abstract
Objective:
To develop a sustainable, scalable methodology for the design of outcome-based agreements (OBAs) that works on the ground and dynamically overcomes historical challenges.
Methods:
Project IDEATE co-created solutions to known (and emergent) challenges via iterative workshops and real-world data analysis to develop and refine a hypothetical model for an OBA in a trusted research environment. A cross-disciplinary collaboration between NHS Wales, industry, and academia was developed. Data were collected from Welsh national datasets and used to inform a novel linked-dataset. OBA scenarios, with different contract parameters, were analysed to assess impact on the proportion of contract payment due and the volatility of payments.
Results:
An approved, in market, locally advanced and metastatic breast cancer treatment was selected as the test case. The total number of patients in the treatment cohort (2017–2020) was n = 99, and 286 in the control cohort (2014–2016). The final outcome variables selected were: 1) 1-year survival, 2) intolerance to treatment (deferral), and 3) the total days disrupted by care. The primary scenario included all three outcomes measured at the population level and used a linear payment model. Volatility analyses demonstrated contract parameters can dramatically alter the contract output with greatest risk from a single, binary outcome contract design.
Conclusions:
The design of an OBA is a complex process that requires a multidisciplinary approach. By better pinpointing which medicines are a good fit for an OBA, assessing solutions to data, outcomes, and contracting challenges, IDEATE provides a strong foundation for future success of OBAs in the UK.