Implementation and results of a risk-sharing scheme for enzyme replacement therapy in lysosomal storage diseases.

OBJECTIVE: To describe a risk-sharing program's implementation and  results on enzyme replacement therapy for lysosomal diseases.

METHOD: The program was designed and implemented in a referral hospital for congenital metabolic diseases. The conclusion of  agreements required the following phases: 1) To define and agree on  response variables and criteria to treatment; 2) to assign discount  percentage to each stage of effectiveness; 3) to prepare and sign the  agreement by all parties; 4) to implement the agreement; 5) to  individualize purchases management; 6) to evaluate clinical results, and  7) to issue an annual report.

RESULTS: Eight patients were included in the program (four with Hurler's disease, two with Pompe and two with Gaucher), five of them  were women and three were men. After analyzing the defined variables  and response criteria, all patients presented full effectiveness after two  or three years of follow-up except one of them that could not be  evaluated. Given the effectiveness achieved, the hospital made full  payment of all administered therapies.

CONCLUSIONS: The implanted risk-sharing program is Spain's first  published event of paying for clinical results using orphan drugs.  Economic impact has been limited, and program implementation has  gone through a complex process of formulation and management.  However, the greatest achievement has been to reduce the knowledge  gap between efficacy and effectiveness, stating that the therapies  administered have shown the optimal benefits for which the funder is  willing to pay.