Outcome-based payment for cancer drugs

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Recent years have seen real improvements in UK patients’ access to newly-launched cancer drugs. However, there remain regulatory and commercial challenges to ensuring patient access to new treatment options is as quick and comprehensive as possible.

Outcome-based payment (OBP) links a drug’s price to the outcomes it delivers for patients in the NHS, and could help improve patient access to evidence-based and cost-effective drugs while extracting maximum value from limited NHS budgets. Cancer Research UK and Greater Manchester Health and Social Care Partnership are therefore jointly undertaking a multi-phase programme of research into the use of OBP in the NHS in England.

Phase 1

The first phase of the research concluded with the publication in February 2019 of a research report based on original research undertaken by the Office of Health Economics, RAND Europe, and King’s College London, available to download from this page.

The report found that wider use of OBP in the NHS is possible and desirable for some (but not all) new cancer drugs. It is best-suited to cases where substantial uncertainty remains about a drug’s effectiveness even after clinical trials data are available.

The report also investigated the treatment outcomes that matter most to patients and carers when receiving treatment with cancer medicines. Based on our findings, the report sets out an “outcomes framework” with four key outcomes: survival; disease progression, recurrence or relapse; long-term side effects; and return to normal activities.

Phase 2

The second phase of the research undertaken by the Office of Health Economics, RAND Europe, University College London and Manchester University was published in November 2021. It sought to understand the extent of existing NHS data capture on these key outcomes and whether these data are in a form suitable for a national-level OBP scheme.

The report found that the outlook on data availability for OBP is positive for clinical outcomes such as survival and disease progression, but that improvements are still needed to capture data on patients’ ability to return to normal activities and their long-term side effects - and to optimise and link these datasets to enable financial decisions.

The research also explored wider practical considerations for implementing OBP schemes in the NHS and found that these mainly relate to agreeing the rebate process and achieving buy-in from clinical staff, Trusts executives, and national system stakeholders.

We will soon begin exploring possibilities for convening relevant stakeholders, to discuss how these challenges can be overcome and recommendations implemented to develop the evidence-base further to understand the viability of OBP schemes in the future.

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