Implementing outcomes-based risk-sharing agreements: an integrative review of applications in blood cancer in the UK and beyond

IntroductionOutcomes-based risk-sharing agreements (OBRSA) have been increasingly used worldwide to manage uncertainty in value assessments. This review aimed to summarize motivations, barriers, and facilitators to implementing OBRSAs with a specific focus on therapies for hematological cancer.Areas coveredAn integrative review was conducted based on a scoping of existing reviews on the topic and reports published by UK NICE. Findings from 16 articles and 10 reports were summarized and categorized into three themes: applications in blood cancer drugs, motivations for adoption, and barriers and facilitators to implementation.Expert opinionThere was a dissociation between the theoretical basis for opting for OBRSAs, and reasons stated or inferred from practice. The administrative burden was considered a notable barrier to implementation, which affects not only payers and manufacturers but also healthcare providers. Effective stakeholder engagement and building mutual trust among key groups were identified as factors enabling successful implementation. The review raises essential considerations in implementing OBRSAs and implications for their future role, particularly for blood cancer drugs where uncertainty is rife. Carefully designed and managed schemes may remain an option for health systems to manage risks involved when funding high-cost treatments.

Automated summary

This review examines the motivations, barriers, and facilitators to implementing outcomes-based risk-sharing agreements (OBRSA) for hematological cancer therapies. The findings suggest that there is a disconnect between the theoretical basis and practical reasons for choosing OBRSAs. Administrative burden is identified as a notable barrier, while effective stakeholder engagement and mutual trust among key groups are identified as facilitators. The review highlights important considerations and implications for the future role of OBRSAs, particularly in the context of blood cancer drugs.