title: Financial consequences of a payment-by-results scheme in Catalonia: gefitinib in advanced EGFR-mutation positive non-small-cell lung cancer.
abstract: BACKGROUND
  In 2011 the first payment-by-results (PbR) scheme in Catalonia was signed between the Catalan Institute of Oncology (ICO), the Catalan Health Service, and AstraZeneca (AZ) for the introduction of gefitinib in the treatment of advanced EGFR-mutation positive non-small-cell lung cancer. The PbR scheme includes two evaluation points: at week 8, responses, stabilization and progression were evaluated, and at week 16 stabilization was confirmed. AZ was to reimburse the total treatment cost of patients that failed treatment, defined as progression at weeks 8 or 16.
  
  
  OBJECTIVE
  To estimate the financial consequences of this PbR reimbursement model and determine the perception of the stakeholders involved in the agreement.
  
  
  METHODS
  Differential drug costs between two scenarios, with and without the PbR, were calculated. A qualitative investigation of the organizational elements was performed by interviewing the parties involved in the agreement.
  
  
  RESULTS
  Forty-one patients were included from June 2011 to October 2013 and assessed at two evaluation points. Clinical results were comparable to those observed in the pivotal studies of gefitinib. The difference in the cost of gefitinib using the PbR compared to the traditional purchasing scenario was 6.17% less at 8 weeks, 11.18% at 16 weeks and 4.15% less for the overall treatment. The PbR resulted in total savings of around €36,000 (€880 per patient). From an operational and organizational perspective, the availability of adequate data systems to measure outcomes and monitor accountability and the involvement of healthcare professionals were acknowledged as crucial.
  
  
  CONCLUSIONS
  Tangible and intangible benefits were identified with respect to the interests of the parties involved. This has led to the incorporation of innovation for patients under acceptable conditions.
authors.affiliation: a Catalan Institute of Oncology , Barcelona , Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Clopes
authors.affiliation: b Catalan Health Service , Barcelona , Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Gasol
authors.affiliation: c AstraZeneca , Madrid , Spain.
authors.forename: Rosana
authors.initials: R
authors.lastname: Cajal
authors.affiliation: d Oblikue Consulting , Barcelona , Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Segú
authors.affiliation: a Catalan Institute of Oncology , Barcelona , Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Crespo
authors.affiliation: b Catalan Health Service , Barcelona , Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Mora
authors.affiliation: c AstraZeneca , Madrid , Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Simon
authors.affiliation: c AstraZeneca , Madrid , Spain.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Cordero
authors.affiliation: a Catalan Institute of Oncology , Barcelona , Spain.
authors.forename: Candela
authors.initials: C
authors.lastname: Calle
authors.affiliation: b Catalan Health Service , Barcelona , Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Gilabert
authors.affiliation: a Catalan Institute of Oncology , Barcelona , Spain.
authors.forename: Josep R
authors.initials: JR
authors.lastname: Germà
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000235:genetics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D066246:ErbB Receptors / Q000235:genetics / Q000627:therapeutic use; D005260:Female; D000077156:Gefitinib; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009154:Mutation; D036301:Qualitative Research; D011799:Quinazolines / Q000191:economics* / Q000627:therapeutic use*; D012052:Reimbursement, Incentive / Q000191:economics*; D013030:Spain
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; C512478:EGFR protein, human; D066246:ErbB Receptors; D000077156:Gefitinib
keywords: Catalonia; Financial consequences; Oncology; Payment by results