Pre-read document 1 : challenges in valuing and paying for combination regimens in oncology

This document was prepared as a pre-read paper for people attending an international workshop convened by Bellberry, Ltd. The workshop was held to discuss the challenges in valuing and paying for combination regimens in oncology. Cancers often arise through multiple biological mechanisms, meaning that treatments that target only one of these mechanisms may not provide long lasting benefit to patients. Therefore, it is common to treat cancers with multiple treatments, called combination therapies. Combination therapies are often expensive, especially when multiple on-patent treatments are combined, which makes paying for them challenging for health systems around the world. This is particularly the case when different companies own the on-patent treatments that are combined, because this may inhibit flexibility in pricing. Hence, this report primarily considers the case where combination therapies consist of two or more on-patent treatments, owned by two or more companies. This pre-read document introduces and illustrates the challenges associated with combination therapies, considers how different approaches used by health systems to determine whether new treatments should be paid for may affect these challenges, and presents a review of options for addressing these challenges, with the aim of facilitating debate on how best to ensure patient access to clinically effective combination therapies.