Making Outcome-Based Payment a Reality in the NHS: Phase 2

Helpful nurse giving pills to senior lady in medical center, photo by Stock Stock

To prepare for the implementation of a pilot scheme to pay for cancer drugs based on achieved outcomes, researchers addressed issues identified in the first phase of research, such as the quality and completeness of real-world data on key patient outcomes.

What is the issue?

In 2018, Cancer Research UK and Greater Manchester Health and Social Care Partnership (GMHSCP) awarded a grant to RAND Europe and the Office of Health Economics (OHE), in collaboration with University College London and University of Manchester, to explore the potential of a model for paying for new cancer medicines based on the outcomes they achieve in practice for NHS patients.

During Phase 1 of the study, researchers explored the published literature relevant to introducing outcome-based payment (OBP) for cancer medicines in the NHS, and established the outcomes that cancer patients valued most from treatment. The study found that OBP could help accelerate patient access to some new medicines and support close monitoring of real-world patient benefit. It also concluded that OBP could promote value for money in NHS spending and support innovation.

How did we help?

With the same funders and research partners, Phase 2 of the study (2019–2020) addressed the practical uncertainties around implementing OBP in the NHS, including the quality and completeness of data—that are already collected or could be in future—on key patient outcomes, and establish next steps for preparing the implementation of a pilot OBP scheme. As a research collaborator, RAND Europe contributed to a variety of methodologies, including interviews and workshops.

What did we find?

The collected data is insufficient for national-level OBP that incorporates patient quality of life outcomes

Data collected through various existing means may be already sufficient for an OBP scheme, but it is still some way from the vision raised in Phase 1 of operating a national-level OBP that incorporates patient quality of life outcomes

Current data collection is promising to meet future needs. However, in the long-term, an OBP scheme would need to include data on additional patient outcomes, such as ability to return to normal activities and patient-reported data on long-term side effects.

Data linkage is needed to enable financial decisions

The ability to clean the data and link different datasets needs further development.

Operational practicalities must be overcome to implement a successful OBP scheme

Cooperation among a host of stakeholders including patients and NHS front-line staff is needed for an OBP scheme to succeed in the long term. Logistical and practical obstacles to OBP can best be addressed by encouraging simplicity and transactability in any design scheme.

OBP offers a 'win' for industry as well as to patients and the NHS

OBP likely reduces the financial risk to the NHS caused by clinical uncertainty. Likewise, it offers benefits to industry, allowing greater manufacturer revenue in cases where simple pricing approaches mean delayed or restricted patient access.

Simplicity and practicality define key characteristics for the design of an OBP

Five 'default' characteristics for a scheme were identified for use within broad and individual contexts.

What did we recommend?

The study offers detailed recommendations to support the implementation of more complex OBP schemes in the long term, if taken forward nationally. These range from improving data collection to support OBP aims, expediting patient access to medicines and optimising organisational and governance aspects of OBP schemes.