Ardito Vittoria, Ciani Oriana, Drummond Michael
Center for Research on Health and Social Care Management (CERGAS), Government Health and Not for Profit (GHNP) Division, SDA Bocconi School of Management, Via Sarfatti, 10, 20136, Milan, Italy.
Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany.
Pharmacoeconomics. 2025 Jan;43(1):5-29. doi: 10.1007/s40273-024-01435-2. Epub 2024 Oct 15.
In a context of growing clinical and financial uncertainty, pricing and payment schemes can act as possible solutions to the problems of affordability and access to health technologies. However, a comprehensive categorization of the available schemes to help decision makers tackle these challenges is lacking. This work aims at mapping existing types of pricing and payment schemes, and proposes a new approach for their classification, in order to help decision makers and other stakeholders select the best type of scheme to meet their needs.
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)-compliant scoping literature review was performed between 2010 and 2023 in three databases (PubMed, Web of Science, Scopus). The search strategy was developed around two groups of keywords, "pricing/payment schemes" and "scheme innovativeness". Eligible studies were those illustrating the unique design and features of each scheme type, which were extracted by two independent reviewers, and synthesized using a narrative format, including a detailed tabular description of each type of scheme.
A total of 70 unique types of pricing and payment schemes were identified. Around one third (33%) was only specified in principle, while two thirds (67%) had been implemented in practice. About half of the scheme types were proposed for drugs (34/70, 49%), and the vast majority were not designed for a specific therapeutic area (55/70, 79%). Each scheme type was categorized based on distinctive characteristics: the objectives, the outcome component, the timing/modalities of payments, and the evidence collection requirements.
Instead of trying to fit the retrieved schemes into a rigid taxonomy, we propose a new approach that suggests a flexible need-driven use of the available scheme types, driven primarily by the specific objective that one might have, and allows leveraging of the other key characteristics of each type of scheme.
在临床和财务不确定性日益增加的背景下，定价和支付方案可作为解决卫生技术可负担性和可及性问题的可能方案。然而，缺乏对现有方案的全面分类以帮助决策者应对这些挑战。本研究旨在梳理现有的定价和支付方案类型，并提出一种新的分类方法，以帮助决策者和其他利益相关者选择最适合其需求的方案类型。
2010年至2023年期间，在三个数据库（PubMed、科学网、Scopus）中进行了一项符合系统评价和Meta分析扩展版的范围综述的首选报告项目（PRISMA-ScR）的范围文献综述。检索策略围绕两组关键词“定价/支付方案”和“方案创新性”制定。符合条件的研究是那些阐述每种方案类型独特设计和特征的研究，由两名独立评审员提取，并采用叙述形式进行综合，包括对每种方案类型的详细表格描述。
共确定了70种独特的定价和支付方案类型。约三分之一（占33%）仅在原则上有规定，而三分之二（占67%）已在实践中实施。约一半的方案类型是针对药物提出的（34/70，占49%），绝大多数并非针对特定治疗领域设计（55/70，占79%）。每种方案类型根据不同特征进行分类：目标、结果组成部分、支付时间/方式以及证据收集要求。
我们并非试图将检索到的方案纳入严格的分类体系，而是提出一种新方法，建议根据具体需求灵活使用现有方案类型，主要由可能的特定目标驱动，并允许利用每种方案类型的其他关键特征。
