Input Parameters for Value-Based Alternative Payment Models in Expensive Drugs in the Western World: A Review and Use Case Study in the Netherlands

OBJECTIVES: The budget impact of expensive drugs in Western countries rises, because of new expensive innovative treatments. From population, hospital and patient perspectives, the need for a value-based alternative payment model (VB-APM) is urgent.

In this study, we explored parameters for a VB-APM for the disease multiple myeloma (MM) as a case study. MM, a plasma cell cancer is exemplary for potentially changing the structure of reimbursement, because of its complexity and practice of innovative treatments in the last decade. We aimed to explore insights in development of a VB-APM for MM in the Netherlands and parameters that affect such VB-APM development and implementation.

METHODS: The first part of this study concerns a scoping review that was conducted using PubMed and Embase. In the second part, semi-structured interviews with 14 stakeholders in and around MM care were performed and analyzed. For the latter analysis, classification of answers in themes was applied.

RESULTS: 31 APMs were included of which only 8 were implemented in practice. More cooperation between stakeholders was mentioned as crucial for almost every type of APM. Often clinical outcome measures or some form of patient reported outcomes were used as parameters in the APM. Themes described by participants were exact content of the concept of VBHC, adequate evaluation of PMs in current health care systems, and needs, barriers, facilitators and strategies for BV-APM development and implementation. Barriers mentioned for change towards value-based payment are lack of cooperation and rigidity of the current healthcare system.

CONCLUSIONS: This study revealed parameters, in development of a VB-APM for MM in the Netherlands. Due to innovation and technology, a VB-APM needs to be dynamic enough.

Furthermore, from the interviews it could be concluded that development of VB-APMs in expensive drugs requires optimization of cooperation, trust and transparency between all stakeholders.