Value in Health最新文献

{"title":"Mapping the Landscape of Open Source Health Economic Models: A Systematic Database Review and Analysis: An ISPOR Special Interest Group Report","authors":"Raymond H. Henderson PhD ,&nbsp;Chris Sampson PhD ,&nbsp;Xavier G.L.V. Pouwels PhD ,&nbsp;Stephanie Harvard PhD ,&nbsp;Ron Handels PhD ,&nbsp;Talitha Feenstra PhD ,&nbsp;Ramesh Bhandari PharmD ,&nbsp;Aryana Sepassi PharmD ,&nbsp;Renée Arnold PharmD","doi":"10.1016/j.jval.2025.01.019","DOIUrl":"10.1016/j.jval.2025.01.019","url":null,"abstract":"<div><h3>Objectives</h3><div>Health economic models are crucial for health technology assessments to evaluate the value of medical interventions. Open-source models (OSMs), in which source code and calculations are publicly accessible, enhance transparency, efficiency, credibility, and reproducibility. This study systematically reviewed databases to map the landscape of available OSMs in health economics.</div></div><div><h3>Methods</h3><div>A systematic database review was conducted, informed by guidance from ISPOR’s OSM Special Interest Group. Eleven databases and specific OSM repositories were searched using predefined terms. Identified models were screened and duplicates were removed.</div></div><div><h3>Results</h3><div>The search yielded 8664 hits, resulting in 182 unique OSMs. GitHub hosted the majority (74%), followed by Zenodo (11%). R was the predominant software platform (64%). Infectious disease was the most common application domain (29%). Markov models were the most frequent model type (49%). Licensing with Creative Commons was typical. Government and academic institutions were the primary sponsors, although many models lacked clear sponsorship.</div></div><div><h3>Conclusions</h3><div>This review highlights the diversity and availability of open-source models (OSMs) in health economics, predominantly hosted on GitHub and developed using R. The models span various medical fields, with a strong focus on infectious diseases, oncology, and neurology. Ensuring clear licensing and standardized reporting is crucial to maximizing their impact. A combined approach of repository searches and traditional literature reviews provides a comprehensive method for identifying OSMs. Future efforts should enhance search strategies, improve reporting standards, and leverage OSMs to inform health policy decisions.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 6","pages":"Pages 813-820"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The New Dutch Guideline for Economic Evaluations in Healthcare: Taking the Societal Perspective to the Next Level","authors":"H. Amarens Geuzinge PhD ,&nbsp;Mohamed El Alili PhD ,&nbsp;Joost J. Enzing PhD ,&nbsp;Leonie M. Huis in ’t Veld MSc ,&nbsp;Saskia Knies PhD ,&nbsp;G. Ardine de Wit PhD ,&nbsp;advisory committee","doi":"10.1016/j.jval.2025.03.002","DOIUrl":"10.1016/j.jval.2025.03.002","url":null,"abstract":"<div><h3>Objectives</h3><div>To promote uniform and high-quality economic evaluations, several national Health Technology Assessment (HTA) bodies have developed guidelines. Because of ongoing (methodological) developments within the field of HTA and economic evaluations, the Dutch health economic guideline needed a revision. This article briefly discusses the process of the latest revision, highlights most important changes, and presents a research agenda with topics for which more research is desired.</div></div><div><h3>Methods</h3><div>An independent committee of 8 Dutch academic HTA experts was installed to advise the National Health Care Institute on this revision. A survey was sent to all relevant stakeholders to obtain input on adjustments needed. The committee discussed the results from the survey and during 4 meetings, formulated its advice accordingly.</div></div><div><h3>Results</h3><div>The most important revisions are a lowered discount rate for costs, additional guidance concerning expert opinion and expert elicitation, the inclusion of health-related quality of life of informal caregivers, performing probabilistic analysis for the main results, indirect medical costs in life years gained, additional guidance on empirical economic evaluations and the inclusion of value of information analyses. Furthermore, the costing manual has been updated as well, including updated reference prices and additional price categories related to educational and judicial costs.</div></div><div><h3>Conclusions</h3><div>The revised Dutch guideline provides up-to-date guidance for conducting economic evaluations in The Netherlands that can inform health policy decisions from a broad societal perspective.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 6","pages":"Pages 930-935"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Low-Value Care in Germany: An Observational Study Using Statutory Health Insurance Data From 2018 to 2021","authors":"Meik Hildebrandt MSc ,&nbsp;Carolina Pioch MSc ,&nbsp;Lotte Dammertz MSc ,&nbsp;Peter Ihle MD ,&nbsp;Monika Nothacker MD ,&nbsp;Udo Schneider Dr rer pol ,&nbsp;Enno Swart Dr rer biol hum ,&nbsp;Reinhard Busse MD, MPH ,&nbsp;Verena Vogt DrPH","doi":"10.1016/j.jval.2024.10.3852","DOIUrl":"10.1016/j.jval.2024.10.3852","url":null,"abstract":"<div><h3>Objectives</h3><div>Low-value care refers to medical services whose benefits do not outweigh the costs and potential harm. This study estimates the prevalence, distribution, and associated costs of 24 low-value care services within the German public healthcare system.</div></div><div><h3>Methods</h3><div>This study was designed as a large-scale retrospective observational study using statutory health insurance data provided by the Techniker Krankenkasse, spanning from 2018 to 2021, covering approximately 11.1 million insured individuals annually. The prevalence of 24 low-value service indicators, which were identified through a systematic review and expert consultations, was calculated. To address uncertainties in distinguishing between appropriate and low-value care, both broad (potential overestimation) and narrow definitions (potential underestimation) were applied to all suitable indicators, providing a range within which the true extent of low-value care is expected to lie.</div></div><div><h3>Results</h3><div>Between 2019 and 2021, 1.6 million patients were identified as having received at least 1 low-value service using the 24 indicators. Of all 10.6 million delivered services (cases) evaluated, on average per year, 1.1 million cases (broad definition) and 0.43 million cases (narrow definition) were classified as low-value care, corresponding to 10.4% and 4.0%, respectively. The costs incurred by the identified services were approximately euros €15.5 million (broad definition) and €9.9 million (narrow definition) annually.</div></div><div><h3>Conclusions</h3><div>Despite the limitations of German statutory health insurance data, considerable low-value care was found within several of the 24 low-value indicators. The findings highlight the necessity for targeted interventions to mitigate low-value care in Germany, guiding healthcare policy and practice to enhance quality and safety effectively.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 6","pages":"Pages 884-893"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Managed Access Protocol for Liraglutide for Weight Management: A Retrospective, Observational Study in Ireland","authors":"Rosealeen Barrett MPharm ,&nbsp;Amelia Smith PhD ,&nbsp;Claire Gorry PhD ,&nbsp;Stephen Doran MSc ,&nbsp;Michael Barry MD ,&nbsp;Laura McCullagh PhD","doi":"10.1016/j.jval.2025.03.017","DOIUrl":"10.1016/j.jval.2025.03.017","url":null,"abstract":"<div><h3>Objectives</h3><div>Pivotal trial data highlight that liraglutide (Saxenda) is effective for weight management, versus placebo. However, cost-effectiveness in Ireland, is not proven. Here, we demonstrate how a Managed Access Protocol (MAP) in Ireland’s healthcare service facilitates access to this high-budget-impact drug in a real-world subpopulation (of the fully licensed population), in whom the intervention is expected to be the most cost-effective, as determined by health technology assessment, while containing overall expenditure.</div></div><div><h3>Methods</h3><div>Two key data sources were analyzed; (1) national anonymized MAP database of liraglutide applications and (2) national reimbursed pharmacy claims database. Key characteristics of the applications approved for reimbursement under the MAP were compared with (1) those of an identified pivotal trial subgroup and (2) those not approved for reimbursement under the MAP. Utilization and expenditure were compared with those predicted in the absence of the MAP.</div></div><div><h3>Results</h3><div>Of the 7927 applications submitted in the first year of the MAP by physicians for individual patients, 52.2% were approved. Differences were noted in most of the key characteristics (including mean age, mean HbA1c, and mean body mass index) in the groups compared. Expenditure on liraglutide was approximately €3.1 million in 2023. Had all applications submitted under the MAP had been approved, expenditure of up to €5.5 million would have been expected.</div></div><div><h3>Conclusions</h3><div>The MAP facilitates access for a subpopulation in whom liraglutide is effective and also expected to be most cost-effective, according to health technology assessment.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 6","pages":"Pages 844-851"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs and Health Outcomes in Economic Evaluations of Person-Centered Care: A Systematic Review","authors":"Hadeel Elhassan MSc ,&nbsp;Salma Pardhan MSc ,&nbsp;Rasika Hewage MSc ,&nbsp;Benjamin P. Harvey MSc ,&nbsp;Hanna Gyllensten PhD","doi":"10.1016/j.jval.2025.03.013","DOIUrl":"10.1016/j.jval.2025.03.013","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim was to explore the current evidence on the costs and cost-effectiveness of person-centered care (PCC). This includes exploring how results vary by populations, settings, and PCC operationalization.</div></div><div><h3>Methods</h3><div>PubMed, Scopus, CINAHL, and gray literature were systematically searched using terms related to PCC and economic evaluations. Selection of studies, extraction of data, and assessment of potential bias using a published checklist were conducted by 2 independent reviewers. Articles were included if indicating PCC as a partnership between carer and patient and reporting costs. Synthesis without meta-analysis was performed using categories based on PCC being either (1) cost-effective, (2) cost saving with negative health outcomes, (3) more costly but effective, or (4) more costly and less effective than usual care, respectively. Classification also considered adherence to the Gothenburg model for PCC cornerstones.</div></div><div><h3>Results</h3><div>Of 2802 articles identified, 44 articles (representing 40 studies) met the specified inclusion criteria. Studies were from the period 1986 to 2021, mostly from high-income countries, and targeting patients above 60 years with long-term condition or multiple comorbidities. Most studies found PCC to be dominating usual care (<em>n</em> = 26), cost-effective (<em>n</em> = 1), or cost saving (<em>n</em> = 3). Only 4 studies found PCC to be dominated by usual care. Limiting the analysis to the cornerstones listed in the Gothenburg model gave similar but limited results.</div></div><div><h3>Conclusions</h3><div>Although most studies found PCC to be cost-effective or cost saving, these findings have limited applicability for system-wide decision making because of significant variations in study methodologies and patient populations.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 6","pages":"Pages 852-865"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US Drug Pricing Patterns Before Loss of Exclusivity","authors":"Ching-Hsuan Lin MD, MPH ,&nbsp;Jonathan D. Campbell PhD ,&nbsp;James Motyka PharmD ,&nbsp;Joshua T. Cohen PhD","doi":"10.1016/j.jval.2025.03.008","DOIUrl":"10.1016/j.jval.2025.03.008","url":null,"abstract":"<div><h3>Objectives</h3><div>Most cost-effectiveness analyses assume that a drug’s price remains unchanged after launch. Because prices typically change, this assumption can distort cost-effectiveness projections. Limited data on how prices change over a drug’s life cycle have limited the inclusion of dynamic pricing assumptions. This study characterized changes in drug prices after launch and before loss of market exclusivity.</div></div><div><h3>Methods</h3><div>We analyzed inflation-adjusted price data for 32 brand-name drugs that contribute substantially to US healthcare spending. We developed 2 regression models: (1) an ordinary least squares regression model to estimate average annual price changes after launch and (2) a linear mixed-effects regression to project how prices change over time. We identified independent factors potentially influencing price changes based on a literature review. We selected factors for model inclusion based on Akaike Information Criterion improvements. Net price data came from SSR Health.</div></div><div><h3>Results</h3><div>The average inflation-adjusted mean annual drug price change was −4.7% (median: −2.4%). The ordinary least squares model predicted negative mean annual price changes for all combinations of drug characteristics except for drugs with Medicare-protected class designations (<em>P</em> value &lt; .01), all else equal. Both models identified drug characteristics associated with smaller price declines or with price increases; the mixed-effects model indicated that price change rates tend to moderate with more time since launch.</div></div><div><h3>Conclusions</h3><div>For large-market branded drugs, inflation-adjusted prices often decline after launch and before loss of market exclusivity. Empirical modeling helps to refine projections based on observable characteristics, thus facilitating incorporation of dynamic pricing into cost-effectiveness analyses.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 6","pages":"Pages 907-914"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Is Distributional Cost-Effectiveness Analysis Not Ready for Prime Time in Health Technology Assessment?","authors":"Sreeram V. Ramagopalan PhD","doi":"10.1016/j.jval.2024.11.015","DOIUrl":"10.1016/j.jval.2024.11.015","url":null,"abstract":"","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 6","pages":"Pages 975-977"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for Type 2 Diabetes Mellitus: A Systematic Review of Recent Economic Evaluations","authors":"Zixuan Jin MPH ,&nbsp;Joshua Rothwell ,&nbsp;Ka Keat Lim MPharm, MSc, PhD","doi":"10.1016/j.jval.2025.01.001","DOIUrl":"10.1016/j.jval.2025.01.001","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine recent economic evaluations and understand whether any type 2 diabetes mellitus (T2DM) screening designs may represent better value for money and to rate their methodological qualities.</div></div><div><h3>Methods</h3><div>We systematically searched 3 concepts (economic evaluations [EEs], T2DM, screening) in 5 databases (Medline, Embase, EconLit, Web of Science, and Cochrane) for EEs published between 2010 and 2023. Two independent reviewers screened for and rated their methodological quality (using the Consensus on Health Economics Criteria Checklist-Extended).</div></div><div><h3>Results</h3><div>Of 32 EEs, a majority were from high-income countries (69%). Half used single biomarkers (50%) to screen adults ≥30 to &lt;60 years old (60%) but did not report locations (69%), treatments for those diagnosed (66%), diagnostic methods (57%), or screening intervals (54%). Compared with no screening, T2DM screening using single biomarkers was found to be not cost-effective (23/54 comparisons), inconclusive (16/54), dominant (11/54), or cost-effective (4/54). Compared with no screening, screening with a risk score and single biomarkers was found to be cost-effective (21/40) or dominant (19/40). The risk score alone was mostly dominant (6/10). Compared with universal screening, targeted screening among obese, overweight, or older people may be cost-effective or dominant. Compared with fasting plasma glucose or fasting capillary glucose, screening using risk scores was found to be mostly dominant or cost-effective. Expanding screening locations or lowering HbA1c or fasting plasma glucose thresholds was found to be dominant or cost-effective. Each EE had 4 to 17 items (median 13/20) on Consensus on Health Economics Criteria Checklist-Extended rated “Yes/Rather Yes.”</div></div><div><h3>Conclusions</h3><div>EE findings varied based on screening tools, intervals, locations, minimum screening age, diagnostic methods, and treatment. Future EEs should more comprehensively report screening designs and evaluate T2DM screening in low-income countries.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 6","pages":"Pages 959-974"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Adolescents Value the EQ-5D-Y-5L and EQ-5D-5L, and How Do the Values Compare? A Feasibility Study","authors":"Trudy A. Sullivan PhD ,&nbsp;Emma H. Wyeth PhD ,&nbsp;Robin M. Turner PhD ,&nbsp;Paul Hansen PhD ,&nbsp;Franz Ombler PhD ,&nbsp;Nancy J. Devlin PhD ,&nbsp;Sarah Derrett PhD","doi":"10.1016/j.jval.2025.02.013","DOIUrl":"10.1016/j.jval.2025.02.013","url":null,"abstract":"<div><h3>Objectives</h3><div>Research into methods for eliciting adolescents’ health state preferences has mostly avoided tasks for identifying health states worse than dead, which is required for calculating quality-adjusted life years for economic evaluations. This study investigated the feasibility of eliciting the health state preferences of older adolescents, including for states worse than dead, using the EQ-5D-Y-5L (Y-5L) and EQ-5D-5L (5L), and compared participants’ preferences across the 2 instruments.</div></div><div><h3>Methods</h3><div>Two online surveys were created for the Y-5L and 5L, respectively, using the Potentially All Pairwise Rankings of all Possible Alternatives method, a type of adaptive discrete choice experiment, and a binary search algorithm for identifying health states worse than dead. The surveys were completed by 24 adolescents aged 16 to 19 years in 2 think-aloud sessions, with semistructured interviews at the end of each session. Dimension preference weights and rankings for the Y-5L and 5L were compared using intraclass correlation coefficients, Bland-Altman plots, and paired <em>t</em> tests.</div></div><div><h3>Results</h3><div>The adolescents were capable of valuing health states and identifying states worse than dead. There is no evidence of a difference in mean preference weights between the Y-5L and 5L, and the rankings of dimensions are similar.</div></div><div><h3>Conclusions</h3><div>Eliciting the health state preferences of older adolescents, including for states worse than dead, is feasible and acceptable. The similarity in Y-5L and 5L mean preference weights suggests that their corresponding value sets, if obtained using the methods used in this study, would be similar. Data quality was enhanced by the surveys being administered in a supportive environment.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 6","pages":"Pages 936-944"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Do Value-Based Contracts Add Value? Insights From Probabilistic Simulations","authors":"Rebecca K. Metcalfe PhD ,&nbsp;Karen Geary MHA ,&nbsp;Mark Trusheim MS ,&nbsp;Jane F. Barlow MD, MPH, MBA ,&nbsp;Quang Vuong MSc ,&nbsp;Jay J.H. Park PhD","doi":"10.1016/j.jval.2025.02.015","DOIUrl":"10.1016/j.jval.2025.02.015","url":null,"abstract":"<div><h3>Objectives</h3><div>Value-based contracts, also called outcomes-based agreements, tie reimbursement to treatment performance, usually operationalized as 1 or more patient outcomes within a given time frame. These agreements offer an appealing risk-sharing mechanism between manufacturers and payers. Despite this, uptake of value-based contracts has been limited likely, in part, because of contract complexity. This study explores how probabilistic simulations can facilitate the planning of value-based contracts while characterizing the net financial benefits based on expected real-world treatment performance, rebate percentage, and the number of patients included in the value-based contract.</div></div><div><h3>Methods</h3><div>We simulated single milestone value-based contracts that would cover treatment of 15 or 100 patients based on a binary outcome of treatment response with 10 000 iterations for each scenario. We considered treatment response rates of 50%, 75%, and 90%, obtained from clinical trials of 30, 100, or 500 patients. We estimated the equivalent discount rates (95% confidence interval) that could be achieved from value-based contracts and descriptively compared the simulation results.</div></div><div><h3>Results</h3><div>Our simulation found that the range of likely value-based contract outcomes increases as the size of the informative trial decreases. We also found that the range of possible rebate amounts is primarily driven by the number of patients treated, not uncertainty in the clinical evidence.</div></div><div><h3>Conclusions</h3><div>Our results suggest differential risk sharing between a payer and a manufacturer and that manufacturers may benefit from a risk-pooling effect by having multiple value-based contracts with multiple payers. Value-based contracts often involve complex trade-offs and multiple sources of uncertainty. Adopting simulation-guided contract planning during the negotiation process can help quantify the financial benefit offered by value-based contracts.</div></div>","PeriodicalId":23508,"journal":{"name":"Value in Health","volume":"28 6","pages":"Pages 839-843"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}