Abstract

Risk-sharing agreements (RSAs) are used in some countries to address the uncertainty about the actual usage and clinical efficacy of drugs in order to manage the healthcare budgets while improving the access of innovative drugs. This study was to understand the current trends, key stakeholders’ opinions, potential success factors, and challenges in the use of RSAs in China. A systematic literature review was conducted using PubMed, CNKI and Wanfang databases, to identify relevant articles in both Chinese and English published up to the end of 2019. Types of RSAs were classified and trends in use were analyzed. Of the 1,533 retrieved studies, ten were finally included for data extraction and analyses. The earliest study was published in 2013 and 70% of studies were published during 2016-2017. Among the included studies, two were empirical analyses while the rest were conceptional. The theoretical model that specifically developed for China was missing in the literature. Three studies included neighboring regions as referencing cases. One study discussed the regional cases in China but did not evaluate the outcomes. Price-volume agreements yield the highest share (30%) of studied RSA types, followed by outcome guarantee (26%). In general, constructing standardized agreements with outcome evaluation systems has been recommended to China’s health authorities. The overall interest in RSAs in China has been increasing for a decade. The publications in RSAs research in China acknowledged that the concepts related to RSAs have been well introduced in China and the impacts had been seen in healthcare policymaking. Further studies are needed to form theoretical suggestions and practice models. To support the nationwide implementation, financial and clinical outcomes of RSAs piloted at the regional level or by commercial insurances are needed to be evaluated.

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