Identifying outcome measures for atrial fibrillation value-based contracting using the Delphi method.

Swart ECS, Good CB, Henderson R, Manolis C, Huang Y, Essien UR, Neilson LM. Identifying outcome measures for atrial fibrillation value-based contracting using the Delphi method. Research in social & administrative pharmacy : RSAP. 2022 Aug 1; 18(8):3425-3431.

Related HSR&D Project(s)

• CDA 20-049 – Access, Quality and Equity of Anticoagulants in Veterans with Atrial Fibrillation

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Abstract:

BACKGROUND: Value-based contracts that tie payments for pharmaceuticals to predefined outcomes aim to promote value through shared risk and aligned incentives between manufacturers and payers. METHODS: We conducted a Delphi study among diverse stakeholders (patients, providers, payers, pharmacy benefits managers, pharmaceutical company representatives) to identify top meaningful outcomes for inclusion in value-based contracts for atrial fibrillation medications. The final panel (n  =  55) rated the importance of each outcome on a 5-point Likert scale and selected their top 3 most meaningful outcomes. Non-patient participants rated the feasibility of collecting each outcome on a 5-point Likert scale. Consensus was defined as = 75% agreement (Likert scores = 4/5 or selection of an outcome as most meaningful). Differences between stakeholder groups were examined using Fisher''s Exact Test. RESULTS: Consensus was achieved for importance of 10 outcomes (Likert scale), where "preventing stroke or mini-stroke" reached 100% agreement (55/55). Eighty-one percent (44/54) of participants selected "preventing stroke or mini-stroke" as the most meaningful outcome (rank order question). The measures rated as most feasibly collected were "reducing hospitalizations" (97%, 36/37) followed by "preventing stroke or mini-stroke" and "reducing emergency department visits" (both 92%, 34/37). There were statistically significant differences between patients and non-patients [0% (0/17) vs 22% (8/37), P  =  0.047] and patients and providers [0% (0/17) vs 39% (7/18), P  =  0.008] in selection of "improving health-related quality of life" as a most meaningful outcome. CONCLUSIONS: These findings will inform the design of atrial fibrillation value-based pharmaceutical contracts and provide additional insight into preferences for outcomes which could be used to improve the quality of atrial fibrillation care.