Why We Need a New Outcomes-Based Value Attribution Framework for Combination Regimens in Oncology

Area of Science:

• Health Economics
• Oncology Therapeutics
• Health Policy

Background:

• Novel oncology treatments increasingly involve combination regimens with complementary mechanisms of action.
• Payers face challenges in reimbursing these combination therapies due to higher costs and longer treatment durations.
• Perceived incremental benefits of add-on therapies over backbone treatments may not align with health system value.

Purpose of the Study:

• To identify when policy challenges arise in the value attribution of combination cancer therapies.
• To outline principles for solutions addressing the value attribution problem in health technology assessment.

Main Methods:

• Development of a simplified conceptual framework to analyze value attribution in combination regimens.
• Examination of the origins of problems in current incremental cost-effectiveness analyses.
• Discussion of novel approaches in the literature designed to address the value attribution challenge.

Main Results:

• Existing approaches to value attribution in combination oncology regimens present policy challenges.
• Neither of the discussed novel approaches fully meets the criteria for resolving the value attribution problem.
• Further research is required to develop a generalizable and transparent solution.

Conclusions:

• The current framework for assessing cost-effectiveness in combination cancer therapy may lead to suboptimal policy decisions.
• Addressing the value attribution problem is crucial for ensuring patient access to effective oncology treatments.
• Refining conceptual frameworks and exploring new methodologies are necessary to resolve this policy challenge.