{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T19:42:03Z","timestamp":1786822923003,"version":"build-2736575974"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Rising drug costs have increased interest in performance-linked reimbursement (PLR) contracts that tie payment to patient outcomes. PLR is theoretically attractive to payers interested in reducing the risk of overpaying for expensive drugs, to manufacturers working to improve early drug adoption, and to patients seeking improved access. Multiple PLR contracts were developed for sacubitril-valsartan. We evaluated how the characteristics of a PLR contract influence its performance.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We used a published cost-effectiveness model of sacubitril-valsartan. We evaluated hypothetical PLR contracts that adjusted drug payment based on observed therapy effectiveness. Ideally, these contracts reduce the uncertainty around the value obtained with purchasing sacubitril-valsartan. By reducing the financial risk in covering an ineffective therapy, PLR incentivizes insurers to increase patient access. We measured the uncertainty in value as the SD of the incremental net monetary benefit (INMB), an estimate of therapy value incorporating costs and clinical benefits. We evaluated the change in INMB SD under a variety of different assumptions regarding contract design, therapy effectiveness, and population characteristics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Over 2 years, sacubitril-valsartan led to 0.042 additional quality-adjusted life-years at an incremental cost of $4916. Using a willingness-to-pay of $150\u2009000 per quality-adjusted life-year, this led to a mean INMB across simulations of $1416 (SD, $1720). A PLR contract that adjusted payment based on cardiovascular mortality reduced the INMB SD moderately by 20.7% while a contract based on all-cause mortality was more effective (INMB SD reduction of 27.3%). A contract based on heart failure hospitalization reduction was ineffective. PLR effectiveness increased with greater uncertainty regarding therapy effectiveness or in sicker cohorts (eg, New York Heart Association Class III\/IV heart failure). Contracts required precise estimates of treatment effect in addition to trust or verifiability between manufacturers and payers concerning patient selection.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The development of accurate prospective estimates of treatment effectiveness using actual enrollee characteristics will be critical for successful PLR. If able to meet these requirements, PLRs could incentivize insurers to expand access to expensive treatments by reducing financial risk.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.121.007993","type":"journal-article","created":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T19:01:11Z","timestamp":1642532471000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Perks and Pitfalls of Performance-Linked Reimbursement for Novel Drugs: The Case of Sacubitril-Valsartan"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3208-1143","authenticated-orcid":true,"given":"Alexander T.","family":"Sandhu","sequence":"first","affiliation":[{"name":"Department of Medicine (A.T.S., P.A.H., J.P.), Stanford University, CA."},{"name":"Veteran\u2019s Affairs Palo Alto Health Care System, CA (A.T.S., P.A.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7730-8490","authenticated-orcid":true,"given":"Paul A.","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Department of Medicine (A.T.S., P.A.H., J.P.), Stanford University, CA."},{"name":"Veteran\u2019s Affairs Palo Alto Health Care System, CA (A.T.S., P.A.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2490-4453","authenticated-orcid":true,"given":"John","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia (J.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Parizo","sequence":"additional","affiliation":[{"name":"Department of Medicine (A.T.S., P.A.H., J.P.), Stanford University, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Center for Health Policy\/Primary Care and Outcomes Research (J.B., J.D.G.-F.), Stanford University, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy D.","family":"Goldhaber-Fiebert","sequence":"additional","affiliation":[{"name":"Center for Health Policy\/Primary Care and Outcomes Research (J.B., J.D.G.-F.), Stanford University, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1512750"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.16843"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pctr.0010009"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.282034"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10198-006-0386-6"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2010.02.005"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2013.04.011"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-153"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-014-0093-x"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2017.23.10.1042"},{"key":"e_1_3_3_12_2","first-page":"1","article-title":"Outcomes-based pharmaceutical contracts: An answer to high U.S. drug spending?","volume":"2017","author":"Seeley E","year":"2017","unstructured":"Seeley, E, Kesselheim, AS. 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