Illustrating the financial consequences of outcome-based payment models from a payers perspective- the case of autologous gene therapy atidarsagene autotemcel (Libmeldy®) (2024)

Callenbach, M. H. E., Schoenmakers, D., Vreman, R. A., Vijgen, S., Timmers, L., Hollak, C. E. M., Mantel-Teeuwisse, A. K. (2024). Illustrating the financial consequences of outcome-based payment models from a payers perspective- the case of autologous gene therapy atidarsagene autotemcel (Libmeldy®). Value in Health. Advance online publication. https://doi.org/10.1016/j.jval.2024.05.010

Callenbach, Marcelien H E ; Schoenmakers, Daphne ; Vreman, Rick A et al. / Illustrating the financial consequences of outcome-based payment models from a payers perspective- the case of autologous gene therapy atidarsagene autotemcel (Libmeldy®). In: Value in Health. 2024.

@article{dcb13bf209f34febb5c854a9c114f3f6,

title = "Illustrating the financial consequences of outcome-based payment models from a payers perspective- the case of autologous gene therapy atidarsagene autotemcel (Libmeldy{\textregistered})",

abstract = "OBJECTIVE: To illustrate the financial consequences of implementing different managed entry agreements ((MEA) for the Dutch healthcare system for autologous gene therapy atidarsagene autotemcel (AA, Libmeldy{\textregistered}), while also providing a first systematic guidance on how to construct MEAs to aid future reimbursem*nt decision-making and create patient access to high-cost, one-off potentially curative therapies.METHODS: Three payment models were compared: (1) an arbitrary 60% price discount, (2) an outcome-based spread payment with discounts, and (3) an outcome-based spread payment linked to a willingness to pay model with discounts. Financial consequences were estimated for full responders (A), patients responding according to the predicted clinical pathway presented in HTA reports (B), and unstable responders (C). The associated costs for an average patient during the timeframe of the payment agreement, the total budget impact, and associated benefits expressed in quality-adjusted life-years of the patient population were calculated.RESULTS: When patients responded according to the predicted clinical pathway presented in HTA reports (Scenario B), implementing outcome-based reimbursem*nt models (models 2 and 3) had lower associated budget impacts while gaining similar benefits compared to the discount (Scenario 1, €8,9 million to €6,6 million vs. €9.2 million). In the case of unstable responders (Scenario C), costs for payers are lower in the outcome-based scenarios (€4.1 million and €3.0 million, Scenario 2.C and 3.C, respectively) compared to implementing the discount (€9.2 million, Scenario 1.C).CONCLUSION: Outcome-based models can mitigate the financial risk of reimbursing AA. This can be considerably beneficial over simple discounts when clinical performance was similar to or worse than predicted.",

author = "Callenbach, {Marcelien H E} and Daphne Schoenmakers and Vreman, {Rick A} and Sylvia Vijgen and Lonneke Timmers and Hollak, {Carla E M} and Mantel-Teeuwisse, {Aukje K} and Goettsch, {Wim G}",

note = "Copyright {\textcopyright} 2024. Published by Elsevier Inc.",

year = "2024",

month = may,

day = "23",

doi = "10.1016/j.jval.2024.05.010",

language = "English",

journal = "Value in Health",

issn = "1098-3015",

publisher = "Elsevier Ltd",

}

Callenbach, MHE, Schoenmakers, D, Vreman, RA, Vijgen, S, Timmers, L, Hollak, CEM, Mantel-Teeuwisse, AK 2024, 'Illustrating the financial consequences of outcome-based payment models from a payers perspective- the case of autologous gene therapy atidarsagene autotemcel (Libmeldy®)', Value in Health. https://doi.org/10.1016/j.jval.2024.05.010

Illustrating the financial consequences of outcome-based payment models from a payers perspective- the case of autologous gene therapy atidarsagene autotemcel (Libmeldy®). / Callenbach, Marcelien H E; Schoenmakers, Daphne; Vreman, Rick A et al.
In: Value in Health, 23.05.2024.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Illustrating the financial consequences of outcome-based payment models from a payers perspective- the case of autologous gene therapy atidarsagene autotemcel (Libmeldy®)

AU - Callenbach, Marcelien H E

AU - Schoenmakers, Daphne

AU - Vreman, Rick A

AU - Vijgen, Sylvia

AU - Timmers, Lonneke

AU - Hollak, Carla E M

AU - Mantel-Teeuwisse, Aukje K

AU - Goettsch, Wim G

N1 - Copyright © 2024. Published by Elsevier Inc.

PY - 2024/5/23

Y1 - 2024/5/23

N2 - OBJECTIVE: To illustrate the financial consequences of implementing different managed entry agreements ((MEA) for the Dutch healthcare system for autologous gene therapy atidarsagene autotemcel (AA, Libmeldy®), while also providing a first systematic guidance on how to construct MEAs to aid future reimbursem*nt decision-making and create patient access to high-cost, one-off potentially curative therapies.METHODS: Three payment models were compared: (1) an arbitrary 60% price discount, (2) an outcome-based spread payment with discounts, and (3) an outcome-based spread payment linked to a willingness to pay model with discounts. Financial consequences were estimated for full responders (A), patients responding according to the predicted clinical pathway presented in HTA reports (B), and unstable responders (C). The associated costs for an average patient during the timeframe of the payment agreement, the total budget impact, and associated benefits expressed in quality-adjusted life-years of the patient population were calculated.RESULTS: When patients responded according to the predicted clinical pathway presented in HTA reports (Scenario B), implementing outcome-based reimbursem*nt models (models 2 and 3) had lower associated budget impacts while gaining similar benefits compared to the discount (Scenario 1, €8,9 million to €6,6 million vs. €9.2 million). In the case of unstable responders (Scenario C), costs for payers are lower in the outcome-based scenarios (€4.1 million and €3.0 million, Scenario 2.C and 3.C, respectively) compared to implementing the discount (€9.2 million, Scenario 1.C).CONCLUSION: Outcome-based models can mitigate the financial risk of reimbursing AA. This can be considerably beneficial over simple discounts when clinical performance was similar to or worse than predicted.

AB - OBJECTIVE: To illustrate the financial consequences of implementing different managed entry agreements ((MEA) for the Dutch healthcare system for autologous gene therapy atidarsagene autotemcel (AA, Libmeldy®), while also providing a first systematic guidance on how to construct MEAs to aid future reimbursem*nt decision-making and create patient access to high-cost, one-off potentially curative therapies.METHODS: Three payment models were compared: (1) an arbitrary 60% price discount, (2) an outcome-based spread payment with discounts, and (3) an outcome-based spread payment linked to a willingness to pay model with discounts. Financial consequences were estimated for full responders (A), patients responding according to the predicted clinical pathway presented in HTA reports (B), and unstable responders (C). The associated costs for an average patient during the timeframe of the payment agreement, the total budget impact, and associated benefits expressed in quality-adjusted life-years of the patient population were calculated.RESULTS: When patients responded according to the predicted clinical pathway presented in HTA reports (Scenario B), implementing outcome-based reimbursem*nt models (models 2 and 3) had lower associated budget impacts while gaining similar benefits compared to the discount (Scenario 1, €8,9 million to €6,6 million vs. €9.2 million). In the case of unstable responders (Scenario C), costs for payers are lower in the outcome-based scenarios (€4.1 million and €3.0 million, Scenario 2.C and 3.C, respectively) compared to implementing the discount (€9.2 million, Scenario 1.C).CONCLUSION: Outcome-based models can mitigate the financial risk of reimbursing AA. This can be considerably beneficial over simple discounts when clinical performance was similar to or worse than predicted.

U2 - 10.1016/j.jval.2024.05.010

DO - 10.1016/j.jval.2024.05.010

M3 - Article

C2 - 38795960

SN - 1098-3015

JO - Value in Health

JF - Value in Health

ER -

Callenbach MHE, Schoenmakers D, Vreman RA, Vijgen S, Timmers L, Hollak CEM et al. Illustrating the financial consequences of outcome-based payment models from a payers perspective- the case of autologous gene therapy atidarsagene autotemcel (Libmeldy®). Value in Health. 2024 May 23. Epub 2024 May 23. doi: 10.1016/j.jval.2024.05.010