Patient-Reported Outcomes Drive Value-Based Care in Multiple Sclerosis
Outcomes-based agreements (OBAs), also referred to as value-based contracts, are gaining momentum in the US as the health care industry transitions from volume-based to value-based care, focusing on improving outcomes while controlling costs. A recent study published in Journal of Managed Care & Specialty Pharmacy explored multiple sclerosis (MS) as a compelling therapeutic area for OBAs by assessing the use of patient-reported disability progression to evaluate treatment effectiveness in real-world settings.
MS represents a compelling therapeutic area for OBAs due to its prevalence, the high cost of medications, and the availability of effective treatment options. The study evaluated findings from an OBA conducted in a large regional health system, focusing on patients with MS prescribed interferon β-1a or dimethyl fumarate. The primary outcome of the OBA was disability progression, assessed using the patient-reported outcome measure known as Patient-Determined Disease Steps (PDDS). This measure, which patients completed during monthly specialty pharmacy refill calls, provided insights into disease progression from the patient perspective.
Eligible participants were health plan members aged 18 or older with an MS diagnosis, continuous health insurance enrollment, and adherence to the prescribed medication. Baseline PDDS scores were collected, with follow-ups occurring between 90 and 180 days postbaseline. A subsequent score was collected if a follow-up score indicated potential disability progression to confirm the finding.
Out of 410 patients eligible for PDDS collection, 184 met the study criteria. Of these, 107 were prescribed dimethyl fumarate, and 77 were prescribed interferon β-1a. The study found that 11.4% of patients experienced confirmed disability progression, with rates of 5.6% for dimethyl fumarate and 19.5% for interferon β-1a. These findings highlight variability in treatment outcomes and underscore the potential of OBAs to operationalize patient-reported outcomes in real-world settings.
The results suggest that incorporating patient-reported outcomes, such as disability progression, into OBAs can provide actionable insights for stakeholders, including payers, manufacturers, and managed care professionals. The study demonstrates the feasibility and value of leveraging OBAs to align pharmaceutical reimbursement with patient-centered outcomes.
“Our findings suggest that meaningful patient-reported outcomes, such as disability progression, can be operationalized in an innovative OBA,” the researchers concluded.
Reference
Swart ECS, Peasah SK, Alderson J, Maxwell R, Manolis C, Good CB. Patient-reported disability progression outcomes among patients with multiple sclerosis: results of an outcomes-based agreement. J Manag Care Spec Pharm. 2024;30(11):1211-1216. doi:10.18553/jmcp.2024.30.11.1211
