The Challenges of Outcomes‑Based Contract Implementation for Medicines in Europe

29 Oct 2021

The aim was to outline the challenges of implementing outcomes-based contracts (OBCs) in Europe.

A scoping review was conducted, building on the searches of a previous systematic review and updating them for December 2017 until May 2021. The combined results were screened, based on inclusion and exclusion criteria. All identified studies published in the English language that described specific OBC schemes for medicines in European countries were included. Insights into the challenges of OBCs were extracted and analysed to develop a conceptual framework.

Ten articles from the previous systematic review matched our inclusion criteria, along with 14 articles from electronic searches. Analysis of these 24 articles and classification of the challenges revealed that there are multiple barriers that must be overcome if OBCs that benefit all stakeholders are going to be adopted widely across Europe. These challenges were grouped according to five key themes: negotiation framework; outcomes; data; administration and implementation; and laws and regulation.

If the promise of OBCs is to be fully realised in Europe, there remain major challenges that need to be overcome by all stakeholders working in partnership. The overlapping and interconnected nature of these challenges highlights the complexity of OBC arrangements.


Natalie Bohm, Sarah Bermingham, Frank Grimsey Jones, Daniela C. Gonçalves‑Bradley, Alex Diamantopoulos, Jessica R. Burton, Hamish Laing