{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:15:57Z","timestamp":1788520557493,"version":"build-2803163510"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The influx of high-cost advanced therapies, particularly CAR T-cell therapies, poses profound economic and operational challenges for healthcare systems in the Gulf Cooperation Council (GCC). As the region transitions from volume-based procurement to Value-Based Healthcare (VBHC), decision-makers must balance the urgent need for innovative curative treatments with fiscal sustainability and limited local health economics data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study utilized a quantitative expert preference rating approach, using a rating-based Conjoint Analysis to assess the utility and relative importance of key value drivers for CAR T-cell therapies. Eighteen Key Opinion Leaders (KOLs) evaluated four hypothetical CAR T-cell product profiles. Individual ratings for sequentially presented attributes were collected from participants and subsequently analyzed using an ordinary least squares (OLS) transformation regression model based on Multi-Attribute Utility Theory (MAUT) to estimate part-worth utilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis identified labeled indications and outcome-based agreements as the dominant drivers of decision-making utility, with markedly higher estimated utility values than upfront price and individual efficacy or safety metrics. Specifically, a cohort-level Outcome-Based Agreements model, where reimbursement is conditional on the response rate of a treated patient population, generated the single highest utility value (U = 24.07). In terms of structural attributes, experts demonstrated a statistically significant preference for comprehensive Patient Support Programs (PSPs) and Technology Transfer commitments (local manufacturing) over simple scientific guidance or basic discounts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Decision-makers in the GCC prioritize risk-sharing mechanisms and broad therapeutic indications over traditional cost-containment strategies when evaluating high-cost CAR T-cell therapies. These findings suggest that to ensure equitable and sustainable patient access, policymakers must establish unified regulatory frameworks that facilitate performance-linked reimbursement models and incentivize the localization of advanced therapy infrastructure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1812612","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T10:26:15Z","timestamp":1788517575000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Expert assessment of the attributes of high-cost medications: a case study of CAR T-cell therapy in the gulf cooperation council"],"prefix":"10.3389","volume":"17","author":[{"given":"Yazed","family":"AlRuthia","sequence":"first","affiliation":[{"name":"Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Al Dallal","sequence":"additional","affiliation":[{"name":"Emirates Health Economics Society","place":["Dubai, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas","family":"Hamad","sequence":"additional","affiliation":[{"name":"Drug Supply Department, Hamad Medical Corporation","place":["Doha, Qatar"]},{"name":"College of Pharmacy, QU Health Sector, Qatar University","place":["Doha, Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Ebrahim","family":"Al Khalifa","sequence":"additional","affiliation":[{"name":"Health Strategic Assessment Directorate, Supreme Council of Health","place":["Manama, Bahrain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sultana","family":"Al-Sabahi","sequence":"additional","affiliation":[{"name":"Ministry of Health","place":["Muscat, Oman"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"Wani","sequence":"additional","affiliation":[{"name":"Ministry of Health","place":["Muscat, Oman"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Alibrahim","sequence":"additional","affiliation":[{"name":"Industrial and Management Systems Engineering, College of Engineering and Petroleum, Kuwait University","place":["Shadadiya, Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibtisam","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Ministry of Defense Health Services","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Alhenaidi","sequence":"additional","affiliation":[{"name":"Director of Health Insurance Directorate, Ministry of Health","place":["Sulaibikhat, Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Almari","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, College of Public Health, Kuwait University","place":["Safat, Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Aloumi","sequence":"additional","affiliation":[{"name":"Pharmaceutical Pricing Department, Medicine and Medical Products Registration and Regulatory Administration, Ministry of Health","place":["Sulaibikhat, Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"Aljalahma","sequence":"additional","affiliation":[{"name":"CEO of Government Hospitals","place":["Manama, Bahrain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.4314\/tjpr.v22i5.27","article-title":"Implementation of risk-sharing agreements in Saudi Arabia: comparison and reflection on the NICE model","volume":"22","author":"Abu-Shraie","year":"2023","journal-title":"Trop. 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