Background:

Outcomes-based models (OBMs) can be used to link the level of reimbursement for a particular medicine to the outcomes that individual patients achieve in clinical practice. These innovative reimbursement models introduce financial ‘risk-sharing’ between manufacturers and payers and promote outcomes measurement within patient care.

Cosentyx^® PROMISE: An Example Outcomes-Based Model:

Novartis UK has implemented an OBM (Cosentyx^® PROMISE) for patients with psoriasis, psoriatic arthritis and ankylosing spondylitis who are prescribed secukinumab (Cosentyx^®) in the UK NHS. In the psoriasis scheme, a rebate on the secukinumab price is provided to the NHS if a patient (biologic-naïve or failed one prior biologic) fails to achieve a reduction in Psoriasis Area Severity Index score >90% (PASI>90) after 16 weeks of treatment. This threshold is more stringent than PASI>75, which is recommended by the National Institute for Health and Care Excellence for assessing biologic response in psoriasis. Novartis actively encourages the monitoring of claims and is committed to ensuring the NHS only pays for successful outcomes.

Outcomes in Psoriasis:

Since its launch in June 2017, agreements have been signed with 65 hospital trusts (37 for psoriasis). Of the 267 psoriasis patients (62% biologic-naïve) who have completed 16 weeks of treatment, 32 (12%) cases have resulted in a rebate, whereas 235 patients (88%) have achieved the desired outcome. In addition to the high PASI>90 rates with secukinumab, and consequent patient management cost-savings, OBMs are expected to deliver value to the NHS compared to traditional payment models based on price and volume alone.

Conclusion:

Cosentyx^® PROMISE demonstrates that OBMs are an innovative approach to achieving patient outcomes whilst supporting NHS financial predictability and sustainability. As well as the advantages to the NHS of ‘risk-sharing’, patients are expected to benefit from the scheme via the use of recommended outcome measures to assess response in clinical practice.