OBJECTIVES: The Italian Medicine Agency (AIFA) has recently introduced conditional reimbursement schemes to promote access to oncology therapies, and reduce the risk of funding treatments with lower effectiveness than observed in clinical trials. These schemes are designed to be terminated after few years once treatment value is reassessed based on available real world data. Payment by Results (PbR) is frequently applied; manufacturers would be asked to pay back the treatment costs for patients receiving the new therapy if progression occurs before a pre-specified threshold. METHODS: A simulation tool was built to assess the impact of the implementing PbR scheme and quantify the resulting increase in clinical value of a new treatment. Progression Free Survival (PFS) curves have been simulated using parametric distributions and hazard ratios to generate various scenarios that may be observed in clinical trials. Patients receiving the new treatment and experiencing a recurrence before the PbR threshold were censored within the survival curves. PbR was also investigated considering Bevacizumab (Bev) in cervical cancer (CC). RESULTS: The improvement in mPFS resulting of PbR was significant and meaningful in every scenario generated. The magnitude of the benefit depended mostly of the shape of parametric distribution. When applied to Bev in CC, a 3-month PbR scheme resulted in an improvement of Bev mPFS from 8.3 to 10.0 months (leading to a 4.1 months median incremental benefit over chemotherapy).  CONCLUSIONS: Based on this simulation study, and the underlying assumptions, the patient access scheme proposed by AIFA would, in most scenarios, be associated with an increase in median incremental benefit for the patients, fewer costs for the payers and therefore better value for money.