Abstract
BackgroundConcerns about financial sustainability of health systems have promoted the adoption of risk-sharing agreements. Nevertheless, few insights have been derived, due to their confidentiality. The purpose of this study is to analyze to what extent these agreements have been implemented in Spain and the importance of several clinical and management variables concerning their use. We also explore whether risk-sharing agreements promote the adoption of personalized medicine. We give a descriptive analysis based on a questionnaire sent to members of the Spanish Society of Hospital Pharmacy, asking about the implementation of risk-sharing contracts in their hospitals.ResultsThere were 80 replies. Implementation of risk-sharing agreements was high (90%), being oncology, neurology, dermatology and infectious diseases the main specialties. The most relevant variables were the number of units of medication per year (89%) in price-volume agreements, and the efficacy and uncertainty of treatments (over 75%) in pay-for-performance agreements. Price-volume agreements were suitable for both conventional and personalized medicine and pay-for-performance more specific for personalized medicine. Paying for performance promotes genetic testing (85%).ConclusionsThe results suggest health authorities should encourage the assessment of financial and health outcomes of real-world contracts of conventional and personalized medicine to better know the variables influencing their use.
Highlights
Concerns about financial sustainability of health systems have promoted the adoption of risk-sharing agreements
We have only found one publication [35] assessing the results of the risk-sharing contract for gefitinib, in Catalonia; other research by Rojas and Antonanzas [36] focused on the perceptions of several stakeholders in Spain about the adequacy of these contracts as a management tool
It is remarkable that the level of use of risk-sharing agreements was high, as 90% of responders stated that they currently had some kind of contract of this type with a pharmaceutical firm, and that they would like to renew them or to sign new ones (96%)
Summary
Concerns about financial sustainability of health systems have promoted the adoption of risk-sharing agreements. Over the last twenty years, public health care systems have adopted several management tools to cope with increasing pressure by pharmaceutical firms to introduce new products, usually at high prices, in a context of uncertainty and budget restrictions These tools have been variously called money-back guarantee schemes, managed entry agreements, coverage with evidence arrangements, pay-forperformance, outcome-based payments, or price-volume agreements. Throughout this paper, we use the term risksharing agreements to refer to both price-volume agreements (mainly intended to ease the financial burden) and pay-for-performance agreements (that link drug payments to clinical outcomes) They are intended to facilitate access to new health technologies when there are uncertainties about clinical results (e.g. medium-run efficacy of treatments and potential target population) and budgetary. As these features will likely be present in the coming decades, it is to be expected that these contracts will become widespread in the future and are likely to be extended to other technologies [7,8,9]
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