OBJECTIVES : To identify and analyse outcomes-based agreements (OBAs) for pharmaceuticals concluded between 2010 and March 2019 in 7 countries: Canada, France, Germany, Italy, the Netherlands, Spain and the UK.

METHODS : Literature review was conducted in the following sources: EMBASE, Medline, HTA agencies’ websites, proprietary databases, grey literature. Information was supplemented by interviews with insiders. Collected data included: indication, ATC code, contract type and date.

RESULTS : Based on publicly available information, 135 OBAs were identified. The majority was of pay-for-performance type (P4P; N=82), followed by coverage with evidence development (CED; N=48). The highest number of OBAs was recorded in Italy (N=54; 51 P4P; 1 mixed; 2 not specified), followed by the UK (N=27; 6 P4P; 20 CED; 1 not specified), the Netherlands (N=22; 4 P4P; 18 CED), France (N=11; 7 P4P; 3 CED; 1 mixed), Spain (N=11; 9 P4P; 2 CED), Canada (N=7; 2 P4P; 5 CED) and Germany (N=3; 3 P4P). Overall no substantial changes in the number of OBAs were noted over the years (10-14 yearly), but some country trends could be seen. After implementation of some contracts in 2010 and 2011 Canada and Germany discontinued OBAs, but in 2018 started to conclude single new ones. Since 2016, the number of OBAs increased in the UK, yet decreased in Italy, while the Netherlands was more active before 2014. No OBAs were concluded in France and Spain since 2017. Oncology drugs accounted for 69% of OBAs (N=93).

CONCLUSIONS : P4P contracts were more common than CED, probably because they protect payers from paying for ineffective treatments. Italy lead in the number of deals, presumably due to a well-developed AIFA IT infrastructure facilitating data collection. Oncology drugs seemed the most suited for OBAs due to precisely defined, short term outcomes, which can be easily agreed on in this therapeutic area.