Not cost-effective at zero price: valuing and paying for combination therapies in cancer

Abstract

Combination therapies are used to treat many cancers. Recently it has become common for newly developed addon treatments to be combined with existing treatments that are relatively new and on-patent. This can result in high costs, leading to affordability challenges for payers and to therapies often being found to not represent value for money by health technology assessment (HTA) agencies and pricing and reimbursement bodies [1]. As a result, patient access to effective novel combination therapies for cancer may be restricted or denied in many health systems. It is not unusual – or in itself a problem – for some treatments to be considered poor value for money. Limits on healthcare budgets mean opportunity cost lies at the heart of HTA. However, when patient access is at risk for a whole category of new, clinically effective treatments, this becomes an important issue. Cost-effectiveness challenges with new treatments can generally be addressed by negotiating treatment price. But some clinically effective combination therapies would not be cost-effective even if the price of the new treatment being added to an existing one was zero. This seems illogical and presents unique challenges to achieving patient access. In this editorial, we summarize these problems and consider how they might be addressed.