OBJECTIVES : In England, certolizumab pegol (CZP) is provided with a value-based agreement (VBA) that offers 12 weeks’ free-of-charge stock for patients enrolled with a homecare provider, irrespective of posology or indication. The payer therefore only pays for CZP when patients respond and continue treatment beyond 12 weeks. The homecare service facilitates patient home administration of CZP, avoiding outpatient appointments. This study aimed to evaluate the impact of the VBA on NHS costs and CZP utilisation in England, as well as stakeholder perceptions of the VBA.

METHODS : This study used a mixed-methods sequential explanatory design. The quantitative element analysed number of CZP prescriptions (March 2009–October 2019) from the manufacturer’s homecare dataset. The qualitative element comprised a 15-minute online questionnaire with 25 pharmacists involved in implementing the VBA, including topics relating to expectations and perceptions of the VBA and time spent administering it; 5 pharmacists underwent a subsequent 45-minute interview on areas for improvement with the VBA. Calculation of outpatient appointment costs avoided through the homecare service was based on the NHS reference cost for a non-Consultant led rheumatology appointment.

RESULTS : The quantitative analysis identified 13,632 patients prescribed CZP, equating to £48.4 million of free stock to the NHS. Assuming that each homecare nurse visit would have required an outpatient appointment in the absence of the homecare service, a maximum of £1.86 million of outpatient appointment costs may have been avoided, in addition to the associated healthcare professional time. Qualitative interviews identified stakeholder agreement that the VBA has optimised medicine utilisation by relieving cost pressure, incentivising patient follow-up and providing a risk-sharing benefit. Identified practical limitations with the scheme included the administrative burden of tracking number of doses against the free-stock allowance.

CONCLUSIONS : The VBA provided substantial free CZP stock to the NHS and provided risk-sharing benefits that supported treatment utilisation by limiting financial risk.