OBJECTIVES: Increasing approvals and rising budget impact of cancer treatments over the past few decades have raised the need for value-based contracting – arrangements between healthcare payers and biopharmaceutical companies that allow coverage of new medicines while accommodating uncertainties around their performance and financial impact. The objective of this study was to identify and analyze publicly available value-based contracts (VBCs) for oncology drugs.

METHODS: A targeted literature review was conducted in PubMed, and supplemented by a grey literature search using Google, HTA websites, and press releases using key search terms for VBCs, oncology, and prescription drugs from 2005-2022.

RESULTS: A total of 526 publicly available VBCs associated with 84 unique drugs with oncology indications were identified. Most of these agreements, 269 (51.1%) were in the European Union (EU), 141 (26.8%) in the United Kingdom (UK), 12 (2.3%) in the United States (US), and the remaining in other countries, including Australia (7.6%), South Korea (7.6%), Israel (4.2%), and China (0.4%). Among EU countries, Italy (49.8%) and Belgium (13.8%) had the most publicly available VBCs. The majority of these VBCs were finance agreements (57.0%), followed by performance-based agreements (24.5%), and confidential/unknown (18.5%). Among finance agreements (n=346), discount (34.7%) was the most common approach. Among the performance-based agreements (n=149), a money-back guarantee (50.3%) was the most common approach followed by payment-by-results (23.5%), and coverage with evidence development (23.5%).

CONCLUSIONS: Most of the publicly available VBCs in oncology were from the EU, with great variability across countries and financial arrangements. Finance-based agreements were more commonly implemented as compared with performance-based agreements. There were limited publicly available VBCs in oncology from the US, however this is likely an underestimation as most of the VBCs are not publicly disclosed. An improved understanding of the VBCs can help in expanding access and value of emerging oncological products.