Challenges in the value assessment, pricing and funding of targeted combination therapies in oncology

Dankó, Dávid; Blay, Jean‐Yves; Garrison, LP

doi:10.1016/j.healthpol.2019.07.009

Cited by 20 publications

(28 citation statements)

References 22 publications

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“…Pertuzumab increased survival but was not considered costeffective even at zero price because all allowable incremental costs were taken up by an increased duration of backbone therapy. Similar findings were present in NICE appraisals of vinflunine for advanced or metastatic transitional cell carcinomona [6,7] and cetuximab for head and neck cancer [7,8], and a previous review in this area undertaken by Danko et al stated that in health systems that estimate cost-effectiveness, "add-on therapies are usually not cost-effective… due to the incremental direct costs of constituent therapies" [1].…”

Section: Combination Therapy: Costs and Valuesupporting

confidence: 70%

“…Challenges associated with the cost and valuation of combination therapies have been outlined before [1][2][3][4][5]. Consider two scenarios.…”

Section: Combination Therapy: Costs and Valuementioning

confidence: 99%

“…Manufacturers will be reluctant to enter price negotiations if the result is a reduced price for indications in which the treatment is already used and accepted as cost-effective. So a form of multi-use pricing is likely to be required, allowing prices to differ for a treatment depending upon the disease area it is being used in, and/or depending on whether it is being used as monotherapy or in a particular combination [1,9,10]. Multi-use pricing has been much debated, with concerns raised (and disputed) around the impact on consumer and producer surpluses [9][10][11][12][13].…”

Section: What Can Be Done?mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

See 3 more Smart Citations

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

Latimer

Towse

Henshall

2021

Expert Review of Pharmacoeconomics & Outcomes Research

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Section: Combination Therapy: Costs and Valuesupporting

confidence: 70%

“…Challenges associated with the cost and valuation of combination therapies have been outlined before [1][2][3][4][5]. Consider two scenarios.…”

Section: Combination Therapy: Costs and Valuementioning

confidence: 99%

Section: What Can Be Done?mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Latimer

Towse

Henshall

2021

Expert Review of Pharmacoeconomics & Outcomes Research

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“…Firstly, the duration of protection from competition depends on national or regional legislation (differences in patent expiration dates, and the commencement and duration of regulatory exclusivity periods). In most countries, data or market exclusivity terms begin on the date of marketing approval in the country or region (Copenhagen Economics, 2018 [51]). Once product/indications are no longer protected, time to generic entry will depend in part on local policy settings.…”

mentioning

confidence: 99%

Challenges in access to oncology medicines

Chapman

Paris

Lopert

2020

OECD Health Working Papers

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Financing and Reimbursement Models for Personalised Medicine: A Systematic Review to Identify Current Models and Future Options

Koleva-Kolarova

Buchanan

Vellekoop

et al. 2022

Appl Health Econ Health Policy

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Background The number of healthcare interventions described as ‘personalised medicine’ (PM) is increasing rapidly. As healthcare systems struggle to decide whether to fund PM innovations, it is unclear what models for financing and reimbursement are appropriate to apply in this context. Objective To review financing and reimbursement models for PM, summarise their key characteristics, and describe whether they can influence the development and uptake of PM. Methods A literature review was conducted in Medline, Embase, Web of Science, and Econlit to identify studies published in English between 2009 and 2021, and reviews published before 2009. Grey literature was identified through Google Scholar, Google and subject-specific webpages. Articles that described financing and reimbursement of PM, and financing of non-PM were included. Data were extracted and synthesised narratively to report on the models, as well as facilitators, incentives, barriers and disincentives that could influence PM development and uptake. Results One hundred and fifty-three papers were included. Research and development of PM was financed through both public and private sources and reimbursed largely through traditional models such as single fees, Diagnosis-Related Groups, and bundled payments. Financial-based reimbursement, including rebates and price-volume agreements, was mainly applied to targeted therapies. Performance-based reimbursement was identified mainly for gene and targeted therapies, and some companion diagnostics. Gene therapy manufacturers offered outcome-based rebates for treatment failure for interventions including Luxturna ® , Kymriah ® , Yescarta ® , Zynteglo ®, Zolgensma ® and Strimvelis ® , and coverage with evidence development for Kymriah ® and Yescarta ® . Targeted testing with OncotypeDX ® was granted value-based reimbursement through initial coverage with evidence development. The main barriers and disincentives to PM financing and reimbursement were the lack of strong links between stakeholders and the lack of demonstrable benefit and value of PM. Conclusions Public-private financing agreements and performance-based reimbursement models could help facilitate the development and uptake of PM interventions with proven clinical benefit. Supplementary Information The online version contains supplementary material available at 10.1007/s40258-021-00714-9.

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Challenges in the value assessment, pricing and funding of targeted combination therapies in oncology

Cited by 20 publications

References 22 publications

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

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

Challenges in access to oncology medicines

Financing and Reimbursement Models for Personalised Medicine: A Systematic Review to Identify Current Models and Future Options

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