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Other skin manifestations.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">2A: Purpura in cryoglobulinemia type I; 2B: Ulcers in cryoglobulinemia type I; 2C: Ulcers in the healing phase in type I cryoglobulinemia; 2D: Coexistence of urticarial vasculitis; 2E: Raynaud's phenomenon</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Panel 3. 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Therapeutic innovation often involves associated uncertainties that make it difficult to establish its therapeutic value under real clinical practice settings and, consequently, the determination of its price and how it will be funded<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a>. These uncertainties stem from the evidence framework available for assessing an innovation, which is limited to the clinical trial setting and difficult to extrapolate results to real clinical practice. These uncertainties could include the effectiveness and safety of the drug, the efficacy compared to alternatives, the real economic impact of the drug, and its cost-effectiveness<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the face of the challenges arising from uncertainties in the evaluation of innovation and in contrast to traditional fixed-price payment schemes, different flexible access models have been proposed and implemented in recent years. The common denominator in all these models is that the benefits and associated risks of uncertainties are shared between the provider and the health system<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>. For this reason, they are called risk-sharing agreements (RSAs), although the terminology varies, and they are also known as <span class="elsevierStyleItalic">Patient Access Scheme</span> (PAS)<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,7</span></a> or <span class="elsevierStyleItalic">Managed Entry Agreements</span> (MEA)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. Flexible models of access to medicines cover a wide spectrum, ranging from financing models, such as price-volume agreements or expenditure limits, to performance-based agreements.</p><p id="par0015" class="elsevierStylePara elsevierViewall">When these models are based on the individual evaluation of results, we speak of pay-for-performance (P4P) schemes or <span class="elsevierStyleItalic">performance-based risk-sharing arrangements</span> (PBRSAs)<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>. In these, the health system only finances the cost of patients who respond to treatment within a certain period of time. P4P schemes are an approach to value-based payment and also have the potential advantage of providing real-life data to feed back into the decision-making system<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although there is a lot of literature describing these models and their potential uses, several reviews acknowledge the paucity of published evaluations regarding the results of their implementation<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The Catalan Institute of Oncology (ICO) is a public company that coordinates and provides cancer care to 50% of the adult population of Catalonia through a multi-centre organisation with activity in four reference centres and network coordination with 20 medium-complexity county hospitals<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>. The management model is based on the commitment to promote corporate social responsibility, including drug administration within the concept of sustainable management. Medicines play a key role in healthcare today, especially in the field of oncology. The provision of quality cancer care and decision-making on medicines is currently subject to a number of factors, such as an increase in the development of new drugs and new therapeutic targets resulting from a high level of research activity worldwide, the academic debate on the contribution of clinical benefit, the discussion of value added and its relation to the definition of price, the increasing economic impact on healthcare systems, and the rising expectations of patients. For this reason, the ICO has opted for a performance-based evaluation in connection with new drugs<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>. This strategy has gone hand in hand with the strategy defined within the framework of the Catalan health system by the Department of Health of the Generalitat de Catalunya, which in its different strategic plans (2011–2015 and 2016–2020) has included the objective of performance-based purchasing in health, including new flexible models of access to medicines<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a>. In 2014, the Servei Català de la Salut published a guide defining the criteria for applying pay-for-performance schemes<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>. This vision, shared from the outset between the Catalan Health Service and the ICO, meant that the ICO was the centre where the first proposals were launched and implemented in Catalonia, some of them subsequently becoming systemic in all Catalan hospitals. The Servei Català de la Salut has also been advancing and implementing these access models in other therapeutic areas.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The hypothesis behind the development of these new access formulas was to make progress in reducing uncertainty, with greater knowledge of the effectiveness, safety and cost-effectiveness of cancer drugs in healthcare practice, guided and facilitated by clinical management, in order to provide therapeutic solutions to patients based on the clinical outcomes obtained. This in turn relates to the assumption that the agreements allow access to the drug product under conditions that monitor and ensure that patients receive the right treatment, while optimising available resources.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The objective of this paper is to review the experience gained in the design and implementation of a P4P scheme in a specialist cancer center in the 10 years since the first agreement was signed. Through this experience review, we aim to analyse the advantages and disadvantages related to the implementation of these new access models.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Material and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">Within the ICO’s strategic processes, the definition and promotion of a drug policy based on rational use has been established<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>. This policy is implemented through the development of guidelines based on evidence and efficiency criteria of the Pharmacotherapeutic Committee, and the design of clinical practice guidelines (ICOPraxis), together with the implementation of these guidelines through clinical management, performance-based approach and networking and collaboration with the hospitals with which ICO has established strategic alliances in the provision of cancer care.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The pillars on which these objectives are developed are the participation of professionals in decisions and the leadership of the pharmacy service in its implementation, together with the definition of a code of interaction between the pharmaceutical and technology industries (CIRIFT), which establishes the framework for collaboration between the ICO and the pharmaceutical industry.</p><p id="par0050" class="elsevierStylePara elsevierViewall">For some years now, the ICO, together with the Catalan Health Service (CatSalut), has been innovating new forms of management, extending strategic alliances not only to other healthcare providers, but also promoting a change in the relationship with the pharmaceutical industry towards a model of public-private collaboration and co-responsibility in health outcomes and sustainability.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The implementation of this relationship between the development of a drug policy in the ICO and the development of P4P schemes is reflected specifically in the roles of:</p><p id="par0060" class="elsevierStylePara elsevierViewall">The Pharmacotherapeutic Committee’s functions include therapeutic positioning, making proposals for drugs that are candidates for P4P schemes and, in the case of an already defined P4P scheme, analysing and approving the criteria.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Interdisciplinary working groups for the development of the ICOPraxis and clinical pathology leaders who define the criteria for patients eligible for P4P schemes and the outcome variables to include.</p><p id="par0070" class="elsevierStylePara elsevierViewall">From the outset it was considered that one of the key elements in the implementation of P4P schemes was to have a performance-based prescribing system. With this vision, ICO has developed a systemic cancer treatment management application called “Eina de Suport al Procés Oncològic de Quimioteràpia” (ESPOQ) (Oncology Process Support Tool for Chemotherapy) that incorporates prescription support tools. These include the ICOPraxis computerized algorithms as decision support at the time of prescription. And as a tool for monitoring performance, ESPOQ includes dynamic forms in which the P4P variables are linked to the drug and indication and to the variable’s recording frequency, which is automated. This application is currently implemented and managing the oncology process in 15 centres of the ICO hospital network.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Early on in the development of these schemes at the ICO it was considered that a clear, measurable, objective, pragmatic and clinically relevant objective is essential in the definition of the P4P variable. If surrogate variables are used, they must be correlated with the endpoint (response versus overall survival) and the methodology must always be based on routine clinical practice and should not generate new structures or needs.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In order to facilitate communication between the stakeholders and the resolution of discrepancies, it was decided to set up joint monitoring committees between the ICO and the pharmaceutical industry. In the event that the P4P scheme from CatSalut was extended to a systemic level for the entire Catalan health system, these committees were expanded to all providers. In these committees and in any information shared, the privacy measures set out in Regulation 2016/679 of the Parliament and Council of 27 April 2016 on the protection of individuals with regard to the processing of personal data<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> must be complied with.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The development phases to date of the P4P implementation process at the ICO have been as follows:</p><p id="par0090" class="elsevierStylePara elsevierViewall">The CatSalut in its 2011–2015 Health Plan<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>, establishes as one of its strategic objectives in the field of Pharmaceutical Care the development of new health care contracting schemes that incorporate payment for some medicines based on clinical outcomes.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the spring of 2010, based on the need to define sustainability plans in Catalan healthcare institutions in the face of the economic crisis, an action plan was drawn up at the ICO with the participation of professionals, and included, as one of the measures in the field of medicines, the start of pilot P4P scheme tests. This action plan was approved by the Pharmacotherapeutic Committee and subsequently by the institution’s own Management Committee. At the same time, within the work of the ICOPraxis lung cancer development group, the professionals proposed to start a pilot test with a drug in this pathology.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Once all the initiatives (CatSalut, institution and professionals) were aligned, negotiations began between the ICO and the supplier of a specific drug, which concluded in early 2011 with the review and approval of the first P4P scheme proposal by the ICO’s Pharmacotherapeutic Committee and with the signing of the three-way agreement: ICO, CatSalut and pharmaceutical industry<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Since the signing and implementation of the first agreement, a dynamic approach has been established at the ICO aimed at including P4P schemes in the discussions of the pharmacotherapeutic committee, in the mindset of its professionals and managers, and in the relationship with the pharmaceutical industry. And at the CatSalut level, the various P4P schemes developed at ICO were expanded and new schemes have subsequently been generated on a systemic basis within the Catalan health system<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Results</span><p id="par0110" class="elsevierStylePara elsevierViewall">From July 2011, the date the first agreement was signed, until November 2020, the implementation of this P4P scheme strategy at ICO has led to the signing of 17 agreements with 15 drugs in seven haematology-oncology diseases (six in oncology and one in haematology). Until November 2020, 2524 patients have been included in these 17 agreements. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the characteristics of these agreements.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The clinical condition in which the P4P scheme was agreed was advanced and/or metastatic disease in 16 of the 17 P4P (94%), with just one agreement in non-advanced disease. Within the P4P group in situations of advanced and/or metastatic disease, nine were in the first line, six in relapse or refractory conditions, and one agreement included both situations.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Of the 17 schemes, all (100%) included the effectiveness variable as a P4P agreement variable for success or failure and, consequently, of economic return, and 10 (59%) assessed and used as a non-response parameter toxicity together with effectiveness, while 41% used effectiveness alone. The variable used in 16 of the 17 agreements was tumour response at different periods, with 13 using the <span class="elsevierStyleItalic">response evaluation criteria in solid tumours</span> (RECIST) and three using other criteria. Only one agreement has used a failure criterion, loss of clinical benefit, considered as the presence of signs or symptoms indicating disease progression, a decrease in <span class="elsevierStyleItalic">Eastern Cooperative Oncology Group</span> scale or disease progression according to RECIST criteria. The assessment time for the effectiveness and toxicity variable(s) was four months or less in 12 schemes and more than four months in five (range six to 12 months), with the majority using a single cut-off point (nine of the 17 agreements), six using two cut-off points and only two agreements using more than two cut-off points, namely four cut-off points.</p><p id="par0125" class="elsevierStylePara elsevierViewall">These agreements have involved 11 different pharmaceutical companies, with an overall consumption generated by the 17 agreements of €56,507,666 and a return to the ICO by the pharmaceutical company for not meeting the success criteria of €2,950,000. The average return of P4P schemes as a whole has been 5.11% (ranging from 0.97 to 22.61%). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> describes the proportion of return (in %) of these P4P schemes according to disease.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Of the 17 agreements, 11 (65%) are still active since their signing and six (35%) have been terminated. The reasons for terminating the latter were the end of the patent and the marketing of generic drugs in three P4P schemes, the change to the financial agreement based on the health outcomes obtained with the P4P scheme in two and the change to another P4P scheme defined with new conditions in one.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Analysis of the first signed agreement was carried out and published in 2017<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>. The main findings of this analysis were that the clinical outcomes under the P4P scheme have managed to match those of the pivotal clinical trial and the analysis of the economic return has accounted for 4.15% of the cost of the treatment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">After analysing the experience of 10 years of P4P scheme design and implementation, the ICO identifies tangible benefits, including giving patients access to new drugs under sustainable conditions. With regard to the return obtained from the P4P schemes and their variability according to drug/disease, a relationship is assessed between return and the clinical benefit that the drug provides, i.e., the greater the clinical benefit and the market price that is more in line with this benefit, the lower the return. This would support the view that P4P schemes are suitable tools for a pay-for-value approach.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In the non-quantitative analysis of the ICO experience, we consider that there are more benefits derived from the intangibles than from the data provided in the study, as the strategy has allowed the alignment of professionals, funders and providers towards performance, focused on standardised use, according to the criteria set out in the agreement, which are evidence-based. The potential impact of P4P scheme from the perspective of narrowing the conditions of use of the therapy is considered by the institution to be of much greater economic relevance than the return of failures themselves, although this is difficult to assess. It makes sense that aligning all actors (manufacturer, payer and practitioners) in the same performance-based use approach provides incentives for optimisation of therapy and its efficient application.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Also, intangible benefits related to properly aligning the interests of all parties are identified in the fact that the P4P schemes have allowed the incorporation of an innovation for patients in acceptable conditions. The professionals, in turn, view these mechanisms positively, as they have been given a key role in defining the clinical characteristics of use and are able to access the use of the product in an appropriate manner. Both the institution and the professionals recognise that the benefit of the experience is not only the potential efficiency gains, but the externalities that derive from the most appropriate use of the medicine in those patients who can benefit most from it together with performance-based funding. For ICO and CatSalut, it has allowed them to strengthen their performance-based drug management policy with the participation of professionals, consolidating the change in the relationship with the pharmaceutical industry focused on co-responsibility for results, while facilitating the development of standardised dynamics for the implementation of P4P schemes in Catalonia.</p><p id="par0155" class="elsevierStylePara elsevierViewall">A value provided by the incorporation of P4P schemes in the work dynamics of an institution such as the ICO is the alignment of the professionals, the institution’s management and the pharmaceutical industry towards a performance-based approach. If we break down these objectives and incorporate other benefits provided, we could conclude that:</p><p id="par0160" class="elsevierStylePara elsevierViewall">It reduces the uncertainty inherent to the incorporation of new drugs into the health system, sharing the risks associated with it between the health funder and the supplier.</p><p id="par0165" class="elsevierStylePara elsevierViewall">It allows the target population to access drugs and avoids the prescription of drugs for off-label indications.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Overall clinical outcomes are achieved in the drug-treated population.</p><p id="par0175" class="elsevierStylePara elsevierViewall">It satisfies clinicians since their uncertainty is reduced.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Limits the budget impact if there is no established health benefit.</p><p id="par0185" class="elsevierStylePara elsevierViewall">It enables robust export and sharing of the results obtained in routine healthcare practice, outside the clinical trial setting.</p><p id="par0190" class="elsevierStylePara elsevierViewall">It encourages the pharmaceutical industry to search for the best drugs in order to strike a balance between quality and economic benefit.</p><p id="par0195" class="elsevierStylePara elsevierViewall">It creates bonds of trust between the academic/healthcare world and the pharmaceutical industry.</p><p id="par0200" class="elsevierStylePara elsevierViewall">In turn, the inconveniences and barriers detected are:</p><p id="par0205" class="elsevierStylePara elsevierViewall">Its implementation requires the existence of powerful information systems that allow reliable monitoring of the treatment’s effectiveness, which can be complex and costly depending on the disease. In a report by the <span class="elsevierStyleItalic">Cancer Network Pharmacist Forum</span> in November 2010<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> warned that the RSAs that had been implemented in the United Kingdom up to that time were too complex and with variables not included in care practices. For this reason, P4P schemes can entail high implementation, follow-up and monitoring costs, with the consequent bureaucratic burden that can hinder a process of therapeutic improvement, a fact described by health centres in the UK. At the ICO, this barrier has been overcome thanks to having developed the ESPOQ tool.</p><p id="par0210" class="elsevierStylePara elsevierViewall">They entail a significant bureaucratic burden and substantial administrative and financial costs. Moreover, the negotiations involved are time-consuming.</p><p id="par0215" class="elsevierStylePara elsevierViewall">High complexity, depending on the characteristics of the technology object of the contract, especially when the agreed results are uncertain and the indicators for their measurement are poorly defined.</p><p id="par0220" class="elsevierStylePara elsevierViewall">If there is not enough trust between the payer and the pharmaceutical company, it will be difficult to make the agreement work well, and conflicts of interest may arise between them.</p><p id="par0225" class="elsevierStylePara elsevierViewall">Its use is not advisable in those treatments whose effects can only be observed in the long term, for which there are no specific, objective and relevant response measures, or for which it is not possible to have a control group.</p><p id="par0230" class="elsevierStylePara elsevierViewall">In our setting, it is necessary to conduct RWE with health outcome and publish the findings, as most international publications present data in aggregate form and many of them have confidentiality agreements on P4P schemes, health outcomes and the reimbursements obtained<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,19</span></a>. A recently published paper by the Organisation for Economic Co-operation and Development reviews the different types and benefits of using new access models, including P4P schemes and the experiences of various countries, and continues to recommend their use, considering their strategic use, proper design and transparency as essential elements<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>. In 2019, the National Health System also published a position paper on the use of P4P schemes specifically in cancer, which indicates that the use of these schemes should be further explored with the aim of facilitating access to drugs when a simple discount cannot be applied<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>. In comparing the experience of the use of flexible agreements for new drugs in Belgium, England, the Netherlands and Sweden (133 agreements in 110 indications), Ferrario et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> report an increasing trend in the use of these schemes. And they also describe a high variability between countries, both in the indications of drugs where an agreement has been applied and in the type of agreement and the conditions in which they are applied. In one of the most data-transparent articles in the literature, Navarria et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> evaluate the Italian experience, reporting economic returns ranging from 39% to 0%, with both P4P schemes and financial arrangements included in this analysis. Published experience to date indicates the increasing trend in the use of risk-sharing arrangements and in particular P4P schemes, and continues to support their use, and above all, it recommends the evaluation of the experience.</p><p id="par0235" class="elsevierStylePara elsevierViewall">It should be taken into account that our health system is quite different from that of these countries. Therefore, evaluations carried out in other countries cannot be extrapolated here. In Spain, apart from the article already mentioned<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>, three texts have been found that evaluate the experience. Darba et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> externally reviewed the experience developed in Catalonia by CatSalut and Edo et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> described the experience of an P4P scheme with enzyme replacement therapies. The experience in Catalonia reported by CatSalut<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>’s own stakeholders includes the description of the methodology of the design and implementation of risk-sharing agreements, both financial and P4P schemes, and indicates that it has been a positive experience, especially in terms of supporting the development of pharmaceutical policy in Catalonia.</p><p id="par0240" class="elsevierStylePara elsevierViewall">In the current situation, it is necessary to search for new efficiency tools to maintain the equity and universality of public health. Therefore, the main motivation for this review based on our own experience is the search for the benefits of P4P schemes and the risks of their application in our institutions’ daily practice.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0245" class="elsevierStylePara elsevierViewall">After reviewing the experience accumulated over 10 years in the design and implementation of P4P schemes in a specialist cancer center, it can be concluded that these schemes address the challenge of the difficult innovation-sustainability balance with new cancer drugs while helping institutions to focus on health outcomes.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Funding</span><p id="par0250" class="elsevierStylePara elsevierViewall">This paper has not received any type of funding.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interests</span><p id="par0255" class="elsevierStylePara elsevierViewall">The authors state that, as managers of a specialist cancer centre, they are ultimately responsible for the procurement of drugs and the approval of clinical trials that are conducted, and clearly have relationships with external suppliers and sponsors. They also declare themselves to be relevant stakeholders in the development of the experience described, with first-hand involvement in its evaluation.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 7 => array:2 [ "identificador" => "xack610226" "titulo" => "Acknowledgements" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-09-07" "fechaAceptado" => "2021-12-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Clopés Estela A, Soler Rotllant F, Germà Lluch JR, Calle Rodríguez C. Esquemas de pago basados en resultados de medicamentos: experiencia de 10 años en un centro monográfico de cancer. Med Clin (Barc). 2022;158:488–492.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">P4P: pay-for-performance schemes.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of pathology \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P4P scheme number \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of patients included \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal cell carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Breast cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">231 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-small cell lung carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">343 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urothelial carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Colorectal cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.065 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glioblastoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">283 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Melanoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">158 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple myeloma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">384 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grand Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.524 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Description of the entities, specifically types of cancer, of the pay-for-performance schemes implemented at the Institut Català d'Oncologia and the number of patients (from July 2011 to November 2020).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">P4P: pay-for-performance scheme.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of cancer \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Proportion P4P scheme return compared to global consumption of the drug (in %) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal cell carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9,40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Breast cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,09 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-small cell lung carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Colorectal cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4,46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urothelial carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18,49 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glioblastoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22,61 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Melanoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3,20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple myeloma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0,97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Global P4P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5,11 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Description of the proportion (%) of return that pay-for-performance schemes entail in the consumption of these drugs according to cancer type (from July 2011 to November 2020).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esquemas innovadores de mejora del acceso al mercado de nuevas tecnologías: Los acuerdos de riesgo compartido" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. 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Journal Information
Vol. 158. Issue 10.
Pages 488-492 (May 2022)
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Vol. 158. Issue 10.
Pages 488-492 (May 2022)
Special article
Pay-for-performance schemes: 10 years’ experience in a comprehensive cancer center
Esquemas de pago basados en resultados de medicamentos: experiencia de 10 años en un centro monográfico de cancer
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Ana Clopés Estelaa,
, Francesc Soler Rotllantb, José Ramón Germà Lluchc, Candela Calle Rodríguezd
Corresponding author
a Dirección Conocimiento e Investigación, Dirección Farmacia, Institut Català d’Oncologia, Hospitalet, Barcelona, Spain
b Dirección asistencial, Institut Català d’Oncologia, Girona, Spain
c Emerito, Institut Català d’Oncologia, Hospitalet, Barcelona, Spain
d Dirección General, Institut Català d’Oncologia, Hospitalet, Barcelona, Spain
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