Presentation (CTI)

OBJECTIVES: Although value-based reimbursement increasingly emphasizes real-world outcomes, medicines and medical services are often evaluated separately, leaving the service-related mechanisms through which innovative medicines generate value insufficiently examined. This study uses innovative subcutaneous (SC) oncology formulations administered in a day care setting to assess how medicines and associated medical services jointly produce value in practice, and whether current payment mechanisms reflect corresponding service resource inputs.
METHODS: We conducted a mixed-methods, real-world study in an oncology day care setting at a tertiary hospital in China. Quantitative operational data were analyzed to evaluate system efficiency. Qualitative process mapping and micro-costing were informed by semi-structured interviews with healthcare professionals, focusing on drug preparation, administration, and post-administration monitoring. Service resource inputs and reimbursement levels under SC day care delivery were compared with traditional inpatient administration.
RESULTS: SC-enabled delivery generated substantial system-level value, with annual service volume increasing by 45.8% and CMI optimizing to 1.24 through released inpatient bed capacity. Patient out-of-pocket costs were substantially lower under SC day care delivery than under inpatient administration. However, this value was co-produced through intensified service inputs: unlike routine injections, SC administration required 10-15 minutes of skilled nursing time, including drug preparation, controlled delivery, and post-administration monitoring. Despite this, fee-for-service schedules reimbursed SC administration at fixed low-tier rates (approximately ¥3-5 per visit), capturing about 30% of comparable inpatient service revenue. Consequently, the service-side contribution to value generation remained financially invisible.
CONCLUSIONS: Innovative therapies generate real-world value through the joint contribution of medicines and intensified medical services. Current payment mechanisms structurally undervalue the service component, creating a disincentive for providers. Integrated value assessment frameworks are essential to align reimbursement with the true costs of value co-production and support the sustainable adoption of innovation.