Presentation (CTI)

OBJECTIVES: Outcome-Based Contracts (OBC) link payment for health technologies to real-world effectiveness. Despite global utilization of OBCs, there are few publications offering structured frameworks to guide development and implementation of OBCs. Our objective was to identify and assess OBC development frameworks using a targeted literature review.
METHODS: We searched PubMed and Google Scholar to identify peer-reviewed articles proposing structured frameworks on OBCs. Frameworks were included if they contained OBC guidance on needs assessment, implementation, or both. Data extraction included information on study characteristics, scope (global vs. regional), steps, and intended use. Frameworks were evaluated and compared to highlight similarities and differences, usage trends, and identify gaps and potential improvements.
RESULTS: Nine frameworks published between 2012 and 2025 were included. Six frameworks were intended for global use, and three frameworks were intended for specific countries (China, Italy, and South Africa). Two frameworks were focused on needs assessment, four on implementation, and three were comprehensive. Earlier frameworks focused more on needs assessment, while later ones were either focused on implementation or comprehensive. Common elements for those including needs assessment were identifying the value of reducing uncertainties (VOI theory) with existing level of evidence, identifying decision problems and cost-effectiveness for treatment, and clarifying the investment and reversal costs. Common elements for those including implementation were determining appropriate outcome measures, identifying clinical uncertainties, data collection strategies, and ownership. Despite overlaps on included elements, unique steps included for comprehensive frameworks included contextual factors (regulatory, political, economic, and technological), cost control plans, setting OBC objectives, iterative processes of renegotiations, and exit strategies for product contract.
CONCLUSIONS: Overall, there was substantial heterogeneity in identified frameworks, with more recent examples being more comprehensive. Additional work may be warranted to standardized guidance and terminologies, allowing for increased efficiency in the development and implementation of OBCs.