Performance-Based Risk-Sharing Arrangements: An Updated International Review
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Enthusiasm for performance-based risk-sharing arrangements (PBRSAs) continues but at variable pace across countries. Our objective was to identify and characterize publicly available cases and related trends for these arrangements. We performed a review of PBRSAs from 1993 to 2016 using the University of Washington PBRSA Database. Arrangements were categorized according to a previously published taxonomy. Macro-level trends were identified related to the timing of adoption, countries involved, types of arrangements, and disease areas. Our search yielded 437 arrangements. Among these, 183 (41.9%) were categorized as currently active, while 58.1% have expired. Five main types of arrangements have been identified, namely coverage with evidence development (149 cases, 34.1%), performance-linked reimbursement (104 cases, 23.8%), conditional treatment continuation (78 cases, 17.8%), financial or utilization (71 cases, 16.2%), and hybrid schemes with multiple components (35 cases, 8.0%). The pace of adoption varies across countries but has renewed an upward trend after a lull in 2012/2013. Conditions in the USA may be changing toward a more favorable environment of PBRSAs. Interest in PBRSAs remains high, suggesting they are a viable coverage and reimbursement mechanism for a wide range of medical products.
All authors contributed to the study conception, design, and writing. Josh Carlson and Shuxian Chen contributed to the data collection and analysis.
Compliance with Ethical Standards
Data Availability Statement
The data that support the findings of this study are available from the University of Washington, but are part of a proprietary database available via a license agreement so are not publicly available.
No sources of funding were used for this review article.
Conflict of interest
Josh J. Carlson, Shuxian Chen, and Louis P. Garrison Jr. declare that they have no conflicts of interest.
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