Department of Economics, University of La Rioja, Logroño, Spain.
Pharmacoeconomics. 2019 Dec;37(12):1469-1483. doi: 10.1007/s40273-019-00838-w.
The aim of this review is to provide a summary of the literature on risk-sharing agreements, including conceptual, theoretical and empirical (number of agreements and their achievements) perspectives, and stakeholders' perceptions.
We conducted a systematic literature search in MEDLINE from 2000 to April 2019, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, and completed it with a manual search of other publications (mainly grey literature). The search was restricted to publications with English abstracts; the initial identification of articles was restricted to the title, abstract and key words fields. The geographical scope was not restricted.
Over 20 studies proposed different taxonomies of risk-sharing contracts, which can be summarised as financial and paying-for-performance agreements. Theoretical studies modelling the incentives to implement risk-sharing agreements are scarce; they addressed different types of contracts and regulatory contexts, characterizing the drug prices and the optimal strategies of the involved agents. Empirical studies describing specific agreements are abundant and referred to different geographical contexts; however, few articles showed the economic results and assessed the value of such contracts. Stakeholders' perceptions of risk-sharing contracting were favourable, but little is known about the economic and clinical advantages of specific agreements. Whether risk-sharing contracts have yielded the desired results for healthcare systems remains uncertain.
Risk-sharing contracts are increasingly used, although the lack of transparency and aggregated registries makes it difficult to learn from these experiences and assess their impact on healthcare systems.
本综述旨在提供风险分担协议文献的概述，包括概念、理论和实证（协议数量及其成就）视角，以及利益相关者的看法。
我们按照 PRISMA（系统评价和荟萃分析的首选报告项目）方法，在 2000 年至 2019 年 4 月期间在 MEDLINE 上进行了系统文献检索，并通过对其他出版物（主要是灰色文献）的手动搜索进行了补充。检索仅限于有英文摘要的出版物；文章的初步识别仅限于标题、摘要和关键词字段。地理范围不受限制。
超过 20 项研究提出了不同的风险分担合同分类法，可以概括为财务和绩效付费协议。理论研究对实施风险分担协议的激励措施进行建模的研究很少；它们涉及不同类型的合同和监管环境，刻画了药品价格和相关代理的最优策略。描述具体协议的实证研究丰富且涉及不同的地理背景；然而，很少有文章展示了这些合同的经济结果并评估了它们的价值。利益相关者对风险分担合同的看法是有利的，但对特定协议的经济和临床优势知之甚少。风险分担合同是否为医疗保健系统带来了预期的结果仍不确定。
风险分担合同的使用越来越多，尽管缺乏透明度和汇总登记册，使得难以从这些经验中学习并评估它们对医疗保健系统的影响。
