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Should health authorities offer risk-sharing contracts to pharmaceutical firms? A theoretical approach

Published online by Cambridge University Press:  22 February 2011

Fernando Antonanzas
Department of Economics, University of La Rioja, Logroño, Spain
Carmelo Juarez-Castello
Department of Economics, University of La Rioja, Logroño, Spain
Roberto Rodriguez-Ibeas*
Department of Economics, University of La Rioja, Logroño, Spain
*Correspondence to: Roberto Rodríguez-Ibeas, Departamento de Economía y Empresa, Universidad de La Rioja, Cigüeña, 60 26004 Logroño, Spain. Email:


In this paper, we characterise the risk-sharing contracts that health authorities can design when they face a regulatory decision on drug pricing and reimbursement in a context of uncertainty. We focus on two types of contracts. On the one hand, the health authority can reimburse the firm for each treated patient regardless of health outcomes (non risk-sharing). Alternatively, the health authority can pay for the drug only when the patient is cured (risk-sharing contract). The optimal contract depends on the trade-off between the monitoring costs, the marginal production cost and the utility derived from treatment. A non-risk-sharing agreement will be preferred by the health authority, if patients who should not be treated impose a relatively low cost to the health system. When this cost is high, the health authority would prefer a risk-sharing agreement for relatively low monitoring costs.

Copyright © Cambridge University Press 2011

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Begg, E., Sidweel, A., Gradiner, S., Nicholls, G.Scott, R. (2003), ‘The sorry saga of the statins in New Zealand-pharmacopolitics versus patient care’, New Zealand Medical Journal, 116(1170): 360.Google Scholar
Chapman, S., Reeve, E., Rajaratnam, G.Neary, R. (2003), ‘Setting up an outcomes guarantee for pharmaceuticals: new approach to risk sharing in primary care’, British Medical Journal, 326: 707709.Google Scholar
Chapman, S., Reeve, E., Price, D., Rajaratnam, G.Neary, R. (2004), ‘Outcomes guarantee for lipid-lowering drugs: results from a novel approach to risk sharing in primary care’, British Journal of Cardiology, 11: 205210.Google Scholar
Claxton, K., Ginelly, L., Sculpher, M., Philips, Z.Palmer, S. (2004), ‘A pilot study and the use of decision theory and value of information analysis as part of the NHS Health Technology Assessment Programme’, Health Technology Assessment, 8(31): 1115.Google Scholar
Department of Health. (2002), Government of United Kingdom. Cost Effective Provision of Disease Modifying Therapies for People with Multiple Sclerosis. Health Service Circular, no. HSC 2002/004, 4 February 2002; Reviewed on 04 February 2005.Google Scholar
Duerden, M., Gogna, N., Godman, B., Eden, K., Mallison, M.Sullivan, N. (2004), ‘Current national initiatives and policies to control drug costs in Europe: UK perspective’, Journal of Ambulatory Care Management, 27: 132138.Google Scholar
Fenwick, E., Claxton, K.Sculpher, M. (2008), ‘The value of implementation and the value of information: combined and uneven development’, Medical Decision Making, 28(1): 2132.Google Scholar
Lilico, A. (2003), ‘Risk-sharing Pricing Models in the Distribution of Pharmaceuticals’, Staff Working Paper, January 2003, Europe Economics, London.Google Scholar
Lu, C. Y., Williams, K., Day, R., March, L., Sansom, L.Bertouch, J. (2004), ‘Access to high cost drugs in Australia’, British Medical Journal, 329: 415416.Google Scholar
Mzarek, M. (2002), ‘Risk-sharing scheme for the provision of MS drugs’, Hospital Pharmacy Europe, 2002: 4044.Google Scholar
Oliva, J., Antoñanzas, F.Rivero-Arias, O. (2008), ‘Evaluación económica y toma de decisiones en salud. El papel de la evaluación económica en la adopción y la difusión de tecnologías sanitarias’, Gaceta Sanitaria, 22, Supplement 1: S137S142.Google Scholar
Pita Barros, P. (2007), ‘The Simple Economics of Risk-Sharing Agreements between NHS and The Pharmaceutical Industry’, MPRA Paper no. 8517, University Library of Munich, Germany (forthcoming in Health Economics).Google Scholar
Pouvourville, G. de. (2006), ‘Risk-sharing agreements for innovative drugs’, European Journal of Health Economics, 7: 155157.Google Scholar
Puig-Junoy, J.Meneu, R. (2005), ‘Aplicación de los contratos de riesgo compartido a la financiación de nuevos medicamentos’, Gestión Clínica y Sanitaria, 7(3): 8894.Google Scholar
Stafinski, T., McCabe, C. J.Menon, D. (2010), ‘Funding the unfundable’, Pharmacoeconomics, 28(2): 113142.Google Scholar
Sudlow, C. L. M.Counsell, C. E. (2003), ‘Problems with UK government's risk sharing scheme for assessing drugs for multiple sclerosis’, British Medical Journal, 326: 388392.Google Scholar
Towse, A.Garrison, L. P. (2010), ‘Can't get no satisfaction? Will pay for performance health?’, Pharmacoeconomics, 28(2): 93102.Google Scholar
Yokota, F.Thompson, K. M. (2004), ‘Value of information literature analysis: a review of applications in health risk management’, Medical Decision Making, 24(3): 287298.Google Scholar
Zaric, G. S.O'Brien, B. J. (2005), ‘Analysis of a pharmaceutical risk sharing agreement based on the purchaser's total budget’, Health Economics, 14: 793803.Google Scholar