Researchers from the HEcoPerMed consortium led by HERC Oxford published an article on “Financing and Reimbursement Models for Personalised Medicine (PM): A Systematic Review to Identify Current Models and Future Options” in Applied Health Economics and Health Policy. This work aimed to review current financing and reimbursement models for PM, summarise their key characteristics, and describe whether they can influence the development and uptake of PM
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. 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.
The key points that decision makers can draw from this work are:
- Appropriate models for financing and reimbursement of personalised medicine are vital to stimulate the development and uptake of these interventions if they are able to show demonstrable clinical benefit.
- Public-private financing agreements and performance-based reimbursement models could help facilitate the development and uptake of PM interventions with proven clinical benefit.
- Defining and measuring performance that reflects the value of PM for the involved stakeholders is still a hurdle to realise the full potential of performance-based reimbursement