Value-based healthcare in practice: IDEATE, a collaboration to design and test an outcomes-based agreement for a medicine in Wales

Burton, Jessica R., Halsby, Kate, de la Fuente, Graciela Sáinz, Pearson-Stuttard, Jonathan, Sloan, Rebecca, Porter, Thomas, John, Gareth, Warburton, Andrew, Selby, Jennifer, Povey, Gail, Chowdhury, Ruhe, Bale, Catherine, Davies, Mark, Clifton-Brown, Emma and Laing, Hamish 2025. Value-based healthcare in practice: IDEATE, a collaboration to design and test an outcomes-based agreement for a medicine in Wales. PharmacoEconomics 43 (2) , pp. 191-207. 10.1007/s40273-024-01445-0

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Abstract

Objective: To develop a sustainable, scalable methodology for the design of outcome-based agreements (OBAs) that works on the ground and dynamically overcomes historical challenges. Methods: Project IDEATE co-created solutions to known (and emergent) challenges via iterative workshops and real-world data analysis to develop and refine a hypothetical model for an OBA in a trusted research environment. A cross-disciplinary collaboration between National Health Service (NHS) Wales, industry and academia was developed. Data were collected from Welsh national datasets and used to construct a novel linked dataset. OBA scenarios, with different contract parameters, were analysed to assess impact on the proportion of contract payment due and the volatility of payments. Results: An approved, in market, locally advanced and metastatic breast cancer treatment was selected as the test case. The total number of patients in the treatment cohort (2017–2020) was n = 99, and 286 in the control cohort (2014–2016). The final outcome variables selected were: (1) 1-year survival,( 2) intolerance to treatment (deferral), and (3) the total days disrupted by care. The primary scenario included all three outcomes measured at the population level and used a linear payment model. Volatility analyses demonstrated contract parameters can dramatically alter the contract output with greatest risk from a single, binary outcome contract design. Conclusions: The design of an OBA is a complex process that requires a multi-disciplinary approach. By assessing solutions to data, outcomes and contracting challenges, IDEATE provides a strong foundation for future success of OBAs in the UK.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Publisher:	Springer
ISSN:	1170-7690
Date of First Compliant Deposit:	13 January 2025
Date of Acceptance:	1 October 2024
Last Modified:	12 Mar 2025 14:15
URI:	https://orca.cardiff.ac.uk/id/eprint/175237

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