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The Challenges of Outcomes-Based Contract Implementation for Medicines in Europe


  • Natalie Bohm

    (Pfizer Limited)

  • Sarah Bermingham

    (Symmetron Limited)

  • Frank Grimsey Jones

    (Symmetron Limited)

  • Daniela C. Gonçalves-Bradley

    (Symmetron Limited)

  • Alex Diamantopoulos

    (Symmetron Limited)

  • Jessica R. Burton

    (Pfizer Limited)

  • Hamish Laing

    (Swansea University)


Objectives The aim was to outline the challenges of implementing outcomes-based contracts (OBCs) in Europe. Methods A scoping review was conducted, building on the searches of a previous systematic review and updating them for December 2017 until May 2021. The combined results were screened, based on inclusion and exclusion criteria. All identified studies published in the English language that described specific OBC schemes for medicines in European countries were included. Insights into the challenges of OBCs were extracted and analysed to develop a conceptual framework. Results Ten articles from the previous systematic review matched our inclusion criteria, along with 14 articles from electronic searches. Analysis of these 24 articles and classification of the challenges revealed that there are multiple barriers that must be overcome if OBCs that benefit all stakeholders are going to be adopted widely across Europe. These challenges were grouped according to five key themes: negotiation framework; outcomes; data; administration and implementation; and laws and regulation. Conclusions If the promise of OBCs is to be fully realised in Europe, there remain major challenges that need to be overcome by all stakeholders working in partnership. The overlapping and interconnected nature of these challenges highlights the complexity of OBC arrangements.

Suggested Citation

  • Natalie Bohm & Sarah Bermingham & Frank Grimsey Jones & Daniela C. Gonçalves-Bradley & Alex Diamantopoulos & Jessica R. Burton & Hamish Laing, 2022. "The Challenges of Outcomes-Based Contract Implementation for Medicines in Europe," PharmacoEconomics, Springer, vol. 40(1), pages 13-29, January.
  • Handle: RePEc:spr:pharme:v:40:y:2022:i:1:d:10.1007_s40273-021-01070-1
    DOI: 10.1007/s40273-021-01070-1

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    References listed on IDEAS

    1. Makady, A. & van Veelen, A. & de Boer, A. & Hillege, H. & Klungel, O.H. & Goettsch, W., 2019. "Implementing managed entry agreements in practice: The Dutch reality check," Health Policy, Elsevier, vol. 123(3), pages 267-274.
    2. Cole, A. & Cubi-Molla, P. & Pollard, J. & Sim, D. & Sullivan, R. & Sussex, J. & Lorgelly, P., 2019. "Making Outcome-Based Payment a Reality in the NHS," Research Papers 002115, Office of Health Economics.
    3. Reyes Lorente & Fernando Antonanzas & Roberto Rodriguez-Ibeas, 2019. "Implementation of risk-sharing contracts as perceived by Spanish hospital pharmacists," Health Economics Review, Springer, vol. 9(1), pages 1-8, December.
    4. Martin Wenzl & Suzannah Chapman, 2019. "Performance-based managed entry agreements for new medicines in OECD countries and EU member states: How they work and possible improvements going forward," OECD Health Working Papers 115, OECD Publishing.
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