DCODE: bringing predictability to UK market access

There wasn’t a single root cause, but rather a convergence of multiple pressures eroding return on investment for life sciences companies. These include a shifting NHS payer and global pharmaceutical landscape, and intensifying NHS financial and demand pressures. Additionally, policy mechanisms such as voluntary project activities (VPAs) have further skewed the balance toward cost containment over broader value considerations like outcomes or industrial contribution. The result is increased launch uncertainty, slower and less predictable uptake and the UK being deprioritised for launches. DCODE was developed to reduce uncertainty and enable more informed, strategic decision-making in this complex environment.

DCODE is designed to identify risks and opportunities across the entire product life cycle, from trial design through to pre-launch planning and post-launch uptake. It operates via a structured framework covering 54 product scenarios for the UK and drawing on over 20,000 data points. The process begins with a pre-assessment to select the appropriate scenario, followed by a detailed market assessment that generates a quantitative risk score benchmarked against an expected range and visualised using a red-amber-green (RAG) system. The assessment is conducted independently by Visions4Health and helps to reduce any potential biases from a manufacturer’s perspective. The assessment report is supported by specific recommendations.

DCODE’s differentiation lies in its structure, reproducibility and breadth. Unlike many internal models, it provides an end-to-end assessment framework rather than fragmented analyses. It is also comparative, allowing benchmarking across therapy areas, and combines real-world insight with data-driven scoring. Crucially, it embeds local healthcare system dynamics into its core methodology, rather than treating the UK as a single, homogeneous market.

While national health technology assessment (HTA) and reimbursement decisions set up the foundation, actual product uptake is driven locally. The NHS operates as a multi-layered system with diverse stakeholder behaviours, priorities and constraints. This results in significant regional variation in prescribing and adoption. DCODE is built on the premise that understanding these local dynamics is essential to accurately assessing access risk. This is something many global or nationally focused models fail to capture.

DCODE integrates evidence from multiple sources, including published NHS data, peer-reviewed literature and direct stakeholder engagement. Post-assessment findings are often supplemented through consultations with NHS leaders and system experts. This ensures that outputs reflect not just theoretical or historical data, but current operational realities and decision-making behaviours within the system.

DCODE has multiple applications: an independent validation of launch strategy, a tool for optimising trial design, a mechanism for portfolio prioritisation and a diagnostic for underperforming products. Its value lies in providing an ‘outside-in’ perspective – combining data and experience to challenge assumptions, surface blind spots and guide strategic action.

DCODE enables more targeted deployment of finite resources by clearly identifying low-risk vs high-risk domains. Through individual products or across a whole portfolio, companies can avoid over-investing in areas where risk is minimal and instead redirect efforts toward areas where risk and uncertainty are higher. It also supports earlier intervention, particularly at trial design stage, ensuring studies are aligned with payer expectations from the outset.

A typical scenario involves identifying misalignment between clinical evidence and payer expectations. For example, a product may demonstrate potential outcomes in reducing hospitalisation but lack the necessary data at the time of HTA review. DCODE flags this as a critical risk and, importantly, identifies ownership within the organisation and recommends mitigation strategies, for example generating additional evidence or adjusting messaging. This dual focus on diagnosis and action is a key strength.

If you are looking to cut through uncertainty and build a market access strategy that works in today’s NHS, or you want to learn more about DCODE and how it can help you, we’d love to talk. Visit www.visions4health.com or contact info@visions4health.com to find out more.

David Cunningham is Senior Consultant at Visions4Health