Making Outcome-Based Payment a Reality in the NHS

Cancer Research UK and Greater Manchester Health and Social Care Partnership (GMHSCP) commissioned the Office of Health Economics and RAND Europe, in collaboration with Professor Richard Sullivan of King's College London, to explore the feasibility of introducing one type of flexible payment mechanism—outcome-based payment (OBP)—for cancer medicines into the NHS in England. This model links the price the NHS pays for a medicine to the outcomes it achieves in practice for NHS patients. OBP could help to accelerate patient access to some new medicines and ensure close monitoring of real-world patient benefit. It can also promote value for money in NHS spending and support innovation emerging from manufacturers. This is especially valuable against the backdrop of rising overall NHS spending on medicines, and of the uncertainty created by the UK's imminent withdrawal from the European Union. The research focused on establishing the treatment outcomes people affected by cancer consider most important, to inform an OBP approach. It included literature reviews, interviews with stakeholders, focus groups and a survey of cancer patients and carers. Based on our findings and analysis we make several recommendations for taking forward OBP for cancer medicines both within Greater Manchester (with its devolved responsibility for NHS and social care) and at a national level. We have focused on specific arrangements in the NHS in England, including the national cancer data infrastructure, which represents a key foundation for any OBP scheme. However, our findings and conclusions remain relevant to decision-makers in the other UK nations and health care systems internationally.