Financing and Reimbursement for Personalised Medicine - Are WE There YET?
Koleva-Kolarova R*1;Buchanan J1;Wordsworth S2, Tsiachristas A1
1University of Oxford, Oxford, UK, 2University of Oxford, Oxford , OXF, UK
METHODS: We performed a systematic literature review in Medline, Embase, Web of Science, Econlit, Google Scholar, Google and subject-specific webpages to identify publications in English between 2009 and 2019 that described financing and reimbursement of PM. Data were synthesised narratively to report on the models, and on incentives and disincentives, facilitators and barriers for PM uptake.
RESULTS: We included 114 papers. R&D of PM was financed through public and private sources. PM was reimbursed mainly through single fees, DRGs, and bundled payments. Risk-sharing outcome-based payments were applied primarily to gene, cell and targeted therapies (Luxturna, Kymriah, Strimvelis), and some companion diagnostics (OncotypeDX). The main barriers and disincentives to adoption of PM were the lack of demonstrable benefit in HTA, and existing reimbursement through billing and coding. Few examples of public-private risk-sharing outcome-based agreements showed potential to facilitate reimbursement and incentivise investment in R&D of PM.
CONCLUSIONS: Public-private financing agreements and risk-sharing outcome-based reimbursement could overcome current limitations in the development and uptake of PM, and pave the way to realise the full benefits of PM on individual health and healthcare system sustainability.
Conference/Value in Health Info
Value in Health, Volume 23, Issue S2 (December 2020)
Health Policy & Regulatory, Study Approaches
Coverage with Evidence Development & Adaptive Pathways, Literature Review & Synthesis, Pricing Policy & Schemes, Reimbursement & Access Policy, Risk-sharing Approaches
Personalized and Precision Medicine