Presentation (CTI)

OBJECTIVES: To investigate whether short-term outcome-based payments can deliver the same incremental net benefit as list price discounts for one-time treatments.
METHODS: A mathematical model estimated the incremental net monetary benefit (INMB) of a one-time treatment under three conditions: list price for all, a short-term outcome-based payment (list price for individuals who experienced an outcome within 12-months), and percentage-discounted list price for all. Improvements in INMB provided by the short-term outcome-based payment and the percentage-discounted list price, relative to the list price for all patients, were compared to establish conditions of equivalence. A probabilistic analysis (three scenarios: low, medium, high uncertainty in the probability of experiencing the outcome) estimated: the expected probability of experiencing the outcome, the expected cost of the short-term outcome-based payment, and the expected difference in cost between payment models.
RESULTS: Short-term outcome-based payments and list price discounting deliver the same improvements to the expected INMB when the percentage discount equals the probability of not experiencing the outcome. In the probabilistic analysis to compare payment models, the difference in the expected cost of treatment was centred around zero.
CONCLUSIONS: For any proposed short-term outcome-based payment model, a discount to the list price of treatments can be calculated that provides identical improvements to the INMB. This proposed discount provides equivalent expected revenue for manufacturers, equivalent budget impact for payers, and equivalent incremental value for decision-makers. If healthcare systems wish to maximise health outcomes from limited resources, and administering short-term outcome-based payment models is costly, then applying an equivalent list price discount may be a viable alternative strategy for decision-makers.