Innovative Contracts Can Address the Value Elements of CGP in Cancer

Laura Joszt, MA
Laura Joszt, MA

Laura is the editorial director of The American Journal of Managed Care® (AJMC®) and all its brands, including The American Journal of Accountable Care®, Evidence-Based Oncology™, and The Center for Biosimilars®. She has been working on AJMC® since 2014 and has been with AJMC®'s parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.

Stakeholders identify the value elements of comprehensive genomic profiling (CGP) they find most important, as well as options for innovative contracts.

Health outcomes, net costs, and reduction in uncertainty are the most important elements of comprehensive genomic profiling (CGP) for cancer treatment, and there is space for innovative contracts that address these elements, but it will be challenging, according to a poster presented at Virtual ISPOR 2021.

“Moving beyond traditional value frameworks and reimbursement models may be necessary to maximize the value and improve decision-making around reimbursement and use of CGP,” the researchers wrote.

They conducted qualitative interviews with 4 providers, 2 health insurers, and 2 employer representatives to identify the value elements of CGP important to stakeholders and understand the opportunities for innovative contracting.

All 4 providers, 1 insurer, and 1 employer representative identified “health outcomes: clinical decision support” as relevant to CGP, making it the top value element, followed by “net costs: general,” “reduction in uncertainty,” and “health outcomes: general.” The value elements considered less relevant for CGP were “value of hope,” “scientific spillovers,” and “equity.”

“CGP potentially plays a role in affecting other novel elements such as equity, scientific spillovers, the value of hope, and clinical trial enrollment; however, these elements were viewed unfavorably by stakeholders, mainly because these elements are considered hypothetical,” said author Woojung Lee, PharmD, PhD student, School of Pharmacy, University of Washington.

The respondents suggested some innovative contracts for CGP. These contracts were broken into 3 main types:

  • Performance- and financial-based contracts, such as paying full costs if the test results change the preferred therapeutic option, a time-driven payment model, paying an incremental cost if CGP provides additional treatment targets, and bundled or episodic payments with quality metrics
  • Not performance- and financial-based, such as bundling the cost of the test with the cost of drugs, a contract that allows for repeated tests at no extra cost, subscription model, and bundled or episodic payments
  • Not performance- and not financial-based, such as a contract to give educational support to providers

The biggest challenge of using innovative contracting for CGP was the administrative burden of tracking patients and assessing response criteria. Other key challenges highlighted were that use of CGP is not standardized, provider groups have their own CGP platform, difficulties choosing appropriate metrics, and that CFP is one piece of the treatment process.

“The administrative burden can be especially an issue for outcomes-guaranteed schemes, where patients often need to be followed up for a long time to observe their treatment outcome, Lee said.

Reference

Lee W, Grueger J, Spencer SJ, Veenstra DL, Carlson JJ. Value frameworks and innovative contracting for comprehensive genomic profiling. Presented at: Virtual ISPOR 2021; May 17-20, 2021. Poster PCN139.