IDEAS home Printed from https://ideas.repec.org/a/spr/aphecp/v20y2022i4d10.1007_s40258-021-00714-9.html
   My bibliography  Save this article

Financing and Reimbursement Models for Personalised Medicine: A Systematic Review to Identify Current Models and Future Options

Author

Listed:
  • Rositsa Koleva-Kolarova

    (University of Oxford)

  • James Buchanan

    (University of Oxford)

  • Heleen Vellekoop

    (Erasmus University Rotterdam)

  • Simone Huygens

    (Erasmus University Rotterdam)

  • Matthijs Versteegh

    (Erasmus University Rotterdam)

  • Maureen Rutten-van Mölken

    (Erasmus University Rotterdam
    Erasmus University Rotterdam)

  • László Szilberhorn

    (Syreon Research Institute
    Eötvös Loránd University)

  • Tamás Zelei

    (Syreon Research Institute)

  • Balázs Nagy

    (Syreon Research Institute)

  • Sarah Wordsworth

    (University of Oxford
    National Institute for Health Research (NIHR) Oxford Biomedical Research Centre)

  • Apostolos Tsiachristas

    (University of Oxford
    National Institute for Health Research (NIHR) Oxford Biomedical Research Centre)

Abstract

Background The number of healthcare interventions described as ‘personalised medicine’ (PM) is increasing rapidly. As healthcare systems struggle to decide whether to fund PM innovations, it is unclear what models for financing and reimbursement are appropriate to apply in this context. Objective To review financing and reimbursement models for PM, summarise their key characteristics, and describe whether they can influence the development and uptake of PM. Methods A literature review was conducted in Medline, Embase, Web of Science, and Econlit to identify studies published in English between 2009 and 2021, and reviews published before 2009. Grey literature was identified through Google Scholar, Google and subject-specific webpages. Articles that described financing and reimbursement of PM, and financing of non-PM were included. Data were extracted and synthesised narratively to report on the models, as well as facilitators, incentives, barriers and disincentives that could influence PM development and uptake. Results One hundred and fifty-three papers were included. Research and development of PM was financed through both public and private sources and reimbursed largely through traditional models such as single fees, Diagnosis-Related Groups, and bundled payments. Financial-based reimbursement, including rebates and price-volume agreements, was mainly applied to targeted therapies. Performance-based reimbursement was identified mainly for gene and targeted therapies, and some companion diagnostics. Gene therapy manufacturers offered outcome-based rebates for treatment failure for interventions including Luxturna®, Kymriah®, Yescarta®, Zynteglo®, Zolgensma® and Strimvelis®, and coverage with evidence development for Kymriah® and Yescarta®. Targeted testing with OncotypeDX® was granted value-based reimbursement through initial coverage with evidence development. The main barriers and disincentives to PM financing and reimbursement were the lack of strong links between stakeholders and the lack of demonstrable benefit and value of PM. Conclusions Public-private financing agreements and performance-based reimbursement models could help facilitate the development and uptake of PM interventions with proven clinical benefit.

Suggested Citation

  • Rositsa Koleva-Kolarova & James Buchanan & Heleen Vellekoop & Simone Huygens & Matthijs Versteegh & Maureen Rutten-van Mölken & László Szilberhorn & Tamás Zelei & Balázs Nagy & Sarah Wordsworth & Apos, 2022. "Financing and Reimbursement Models for Personalised Medicine: A Systematic Review to Identify Current Models and Future Options," Applied Health Economics and Health Policy, Springer, vol. 20(4), pages 501-524, July.
  • Handle: RePEc:spr:aphecp:v:20:y:2022:i:4:d:10.1007_s40258-021-00714-9
    DOI: 10.1007/s40258-021-00714-9
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s40258-021-00714-9
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.

    File URL: https://libkey.io/10.1007/s40258-021-00714-9?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Meckley, Lisa M. & Neumann, Peter J., 2010. "Personalized medicine: Factors influencing reimbursement," Health Policy, Elsevier, vol. 94(2), pages 91-100, February.
    2. Hanna, E. & Toumi, M. & Dussart, C. & Borissov, B. & Dabbous, O. & Badora, K. & Auquier, P., 2018. "Funding breakthrough therapies: A systematic review and recommendation," Health Policy, Elsevier, vol. 122(3), pages 217-229.
    3. Dankó, D. & Blay, J-Y. & Garrison, L.P., 2019. "Challenges in the value assessment, pricing and funding of targeted combination therapies in oncology," Health Policy, Elsevier, vol. 123(12), pages 1230-1236.
    4. Mark V. Pauly, 2017. "Cost Sharing in Insurance Coverage for Precision Medicine," NBER Working Papers 24095, National Bureau of Economic Research, Inc.
    5. Helen Dakin & Alastair Gray, 2018. "Decision Making for Healthcare Resource Allocation: Joint v. Separate Decisions on Interacting Interventions," Medical Decision Making, , vol. 38(4), pages 476-486, May.
    6. Carlson, Josh J. & Sullivan, Sean D. & Garrison, Louis P. & Neumann, Peter J. & Veenstra, David L., 2010. "Linking payment to health outcomes: A taxonomy and examination of performance-based reimbursement schemes between healthcare payers and manufacturers," Health Policy, Elsevier, vol. 96(3), pages 179-190, August.
    7. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    8. Andersson, Emelie & Svensson, Johanna & Persson, Ulf & Lindgren, Peter, 2020. "Risk sharing in managed entry agreements—A review of the Swedish experience," Health Policy, Elsevier, vol. 124(4), pages 404-410.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Marcelien H. E. Callenbach & Rick A. Vreman & Aukje K. Mantel-Teeuwisse & Wim G. Goettsch, 2022. "When Reality Does Not Meet Expectations—Experiences and Perceived Attitudes of Dutch Stakeholders Regarding Payment and Reimbursement Models for High-Priced Hospital Drugs," IJERPH, MDPI, vol. 20(1), pages 1-12, December.
    2. Wettstein, Dominik J. & Boes, Stefan, 2022. "How value-based policy interventions influence price negotiations for new medicines: An experimental approach and initial evidence," Health Policy, Elsevier, vol. 126(2), pages 112-121.
    3. Carolina Zampirolli Dias & Brian Godman & Ludmila Peres Gargano & Pâmela Santos Azevedo & Marina Morgado Garcia & Maurílio Souza Cazarim & Laís Lessa Neiva Pantuzza & Nelio Gomes Ribeiro-Junior & Andr, 2020. "Integrative Review of Managed Entry Agreements: Chances and Limitations," PharmacoEconomics, Springer, vol. 38(11), pages 1165-1185, November.
    4. Rick A Vreman & Thomas F Broekhoff & Hubert GM Leufkens & Aukje K Mantel-Teeuwisse & Wim G Goettsch, 2020. "Application of Managed Entry Agreements for Innovative Therapies in Different Settings and Combinations: A Feasibility Analysis," IJERPH, MDPI, vol. 17(22), pages 1-20, November.
    5. İlkay Unay-Gailhard & Mark A. Brennen, 2022. "How digital communications contribute to shaping the career paths of youth: a review study focused on farming as a career option," Agriculture and Human Values, Springer;The Agriculture, Food, & Human Values Society (AFHVS), vol. 39(4), pages 1491-1508, December.
    6. Mahin Ghafari & Vali Baigi & Zahra Cheraghi & Amin Doosti-Irani, 2016. "The Prevalence of Asymptomatic Bacteriuria in Iranian Pregnant Women: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-10, June.
    7. Elizabeth T Cafiero-Fonseca & Andrew Stawasz & Sydney T Johnson & Reiko Sato & David E Bloom, 2017. "The full benefits of adult pneumococcal vaccination: A systematic review," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-23, October.
    8. Santos Urbina & Sofía Villatoro & Jesús Salinas, 2021. "Self-Regulated Learning and Technology-Enhanced Learning Environments in Higher Education: A Scoping Review," Sustainability, MDPI, vol. 13(13), pages 1-12, June.
    9. Oded Berger-Tal & Alison L Greggor & Biljana Macura & Carrie Ann Adams & Arden Blumenthal & Amos Bouskila & Ulrika Candolin & Carolina Doran & Esteban Fernández-Juricic & Kiyoko M Gotanda & Catherine , 2019. "Systematic reviews and maps as tools for applying behavioral ecology to management and policy," Behavioral Ecology, International Society for Behavioral Ecology, vol. 30(1), pages 1-8.
    10. Nadine Desrochers & Adèle Paul‐Hus & Jen Pecoskie, 2017. "Five decades of gratitude: A meta‐synthesis of acknowledgments research," Journal of the Association for Information Science & Technology, Association for Information Science & Technology, vol. 68(12), pages 2821-2833, December.
    11. Maryono, Maryono & Killoes, Aditya Marendra & Adhikari, Rajendra & Abdul Aziz, Ammar, 2024. "Agriculture development through multi-stakeholder partnerships in developing countries: A systematic literature review," Agricultural Systems, Elsevier, vol. 213(C).
    12. Alene Sze Jing Yong & Yi Heng Lim & Mark Wing Loong Cheong & Ednin Hamzah & Siew Li Teoh, 2022. "Willingness-to-pay for cancer treatment and outcome: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(6), pages 1037-1057, August.
    13. Xue-Ying Xu & Hong Kong & Rui-Xiang Song & Yu-Han Zhai & Xiao-Fei Wu & Wen-Si Ai & Hong-Bo Liu, 2014. "The Effectiveness of Noninvasive Biomarkers to Predict Hepatitis B-Related Significant Fibrosis and Cirrhosis: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-16, June.
    14. Vicente Miñana-Signes & Manuel Monfort-Pañego & Javier Valiente, 2021. "Teaching Back Health in the School Setting: A Systematic Review of Randomized Controlled Trials," IJERPH, MDPI, vol. 18(3), pages 1-18, January.
    15. Agnieszka A. Tubis & Katarzyna Grzybowska, 2022. "In Search of Industry 4.0 and Logistics 4.0 in Small-Medium Enterprises—A State of the Art Review," Energies, MDPI, vol. 15(22), pages 1-26, November.
    16. Leopold, C. & Vogler, S. & Habl, C. & Mantel-Teeuwisse, A.K. & Espin, J., 2013. "Personalised medicine as a challenge for public pricing and reimbursement authorities – A survey among 27 European countries on the example of trastuzumab," Health Policy, Elsevier, vol. 113(3), pages 313-322.
    17. Obsa Urgessa Ayana & Jima Degaga, 2022. "Effects of rural electrification on household welfare: a meta-regression analysis," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 69(2), pages 209-261, June.
    18. Caloffi, Annalisa & Colovic, Ana & Rizzoli, Valentina & Rossi, Federica, 2023. "Innovation intermediaries' types and functions: A computational analysis of the literature," Technological Forecasting and Social Change, Elsevier, vol. 189(C).
    19. García-Poole, Chloe & Byrne, Sonia & Rodrigo, María José, 2019. "How do communities intervene with adolescents at psychosocial risk? A systematic review of positive development programs," Children and Youth Services Review, Elsevier, vol. 99(C), pages 194-209.
    20. Jie Zhao & Ji Chen & Damien Beillouin & Hans Lambers & Yadong Yang & Pete Smith & Zhaohai Zeng & Jørgen E. Olesen & Huadong Zang, 2022. "Global systematic review with meta-analysis reveals yield advantage of legume-based rotations and its drivers," Nature Communications, Nature, vol. 13(1), pages 1-9, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:aphecp:v:20:y:2022:i:4:d:10.1007_s40258-021-00714-9. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.