The backbone is typically already approved for use as a monotherapy, and sometimes the standard of care in treating a disease. The add-on may be specifically designed to work in combination with the backbone therapy or already be in the market as an independent monotherapy.
CTs are increasingly used in oncology, with the trend upwards expected to continue. The European Federation of Pharmaceutical Industries and Associations (EFPIA) predicts that around 68 CTs in oncology will launch between 2023 and 2028. In addition, the Association of the British Pharmaceutical Industry (ABPI) reports that CTs make up almost half of the pipeline of companies that focus on developing cancer treatments.
However, there are significant barriers to patient access to CTs, including the prevailing value attribution and pricing models used in Europe. It is crucial that we move beyond these barriers to ensure patients can benefit from the most effective and cost-effective treatments possible.
OHE has played a role in understanding and addressing the challenges for attributing value to and pricing combination therapies, with two recent reports on the topic.
Current approaches to pricing CTs assume the backbone therapy maintains its current price, typically that for its use as a monotherapy. This price however, does not necessarily reflect the value it brings to the combination therapy and consequently it may leave little room for the add-on to achieve a value-based price as well, especially if both treatments are used for a longer duration e.g. with extended survival. In some circumstances, this can also lead to the add-on being deemed “not cost-effective at zero price”.
The first of the OHE reports explores how alternative value attribution frameworks contribute to overcoming these issues,provides a solution to the value attribution problem. , and reports industries’ views amongst others on its appropriateness and feasibility in comparison to alternative attribution frameworks.
Another OHE report makes recommendations on the pricing approaches that should be taken to enable access to CTs. It recommends ‘combination-based differential pricing’, whereby the price of the individual monotherapies differs depending on its usage. Such pricing may be aligned with the value of the therapy or volume of sales.
The next steps will involve understanding how these different policy options can be used in practice whilst assessing the feasibility of implementation in a range of payer archetypes, health data infrastructures and competition law provisions.
