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


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 King’s College London, 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 feasibility of introducing outcome-based payment (OBP) for cancer medicines in the NHS, as well as the outcomes that cancer patients valued most from treatment. The study found that OBP could help accelerate patient access to some new medicines, and ensure close monitoring of real-world patient benefit. It also concluded that OBP could promote value for money in NHS spending and support innovation.


For Phase 2 of the study, in 2019-2020, RAND Europe, OHE, University College London and The University of Manchester have been commissioned by Cancer Research UK and GMHSCP to build on Phase 1. The Phase 2 study will address the uncertainties identified in the first phase, such as the quality and completeness of real-world data on key patient outcomes, and establish next steps for preparing the implementation of a pilot OBP scheme in Greater Manchester.

The specific research aims are to:

  • Identify what data are available within the NHS to support an outcome-based payment scheme based on the outcomes framework developed in Phase 1, and understand the options and feasibility for collecting further data as required for the scheme’s operation.
  • Identify classes of medicines and/or cancer types for which these existing NHS data could most meaningfully function as relevant clinical and patient-reported outcomes.
  • Understand the practicalities of operating an outcome-based payment scheme and develop theoretical models for how prices could be linked to outcomes (including the relative weighting of different patient outcomes).
  • Conduct a preliminary retrospective analysis and theoretical testing of an outcome-based payment scheme based on the principles outlined in Phase 1, using data from Greater Manchester and in classes of medicines and/or cancer types identified as most suitable.
  • Use the above outputs to produce recommendations for the design of the final, pilot phase of the programme.


As part of the research collaboration, RAND Europe will be feeding into a variety of research methodologies, including establishing a set of metrics, horizon scanning activities, interviews, workshops and data analysis.