Pricing Complexities of
a Combination Therapy
Content for this article was provided by EVERSANA’s Asia Pacific team.
The use of combination therapies in oncology has been
increasing over time. As combination therapies target
multiple pathways simultaneously, they can offer better
clinical outcomes than monotherapies. A recent study
by the Cancer Research Institute (CRI) found the ratio of
monotherapy PD-1/PD-L1–blocking drug trials continues
to decrease, while the number of combination studies is
on the rise.
Combination therapies consist of a “backbone” therapy
and one or more “add-on” therapies. A backbone
therapy is a drug or drug combination that is already
approved for use. An add-on therapy is a drug or set of
drugs added to the backbone therapy. They may have
been present in the market as independent therapies or
have been developed specifically as a combination with
a backbone therapy.
Although combination therapies have added benefits
and clinical trials focusing on combination therapies
are increasing, assessing the value and pricing of
combination therapies is a challenge.
W H Y IS THIS?
Understanding the Challenges
Associated with Combination Therapies
Combination treatments are evaluated as a single
therapy, but the individual components are priced
independently. The backbone therapy already has a
market price and is unlikely to be reassessed. When the
combination therapy is evaluated, the value attributed
to the add-on therapy is only the residual value of the
combination once the existing price of the backbone
therapy is removed. This means there is limited
pricing scope for the add-on therapy, especially if the
backbone therapy is a novel treatment with a high price.
Further complications arise if the components of the
combination therapy are manufactured by different
companies. Manufacturers of the add-on therapy will
have limited control over the price of the combination
and, consequently, their own product.
Combination therapies also may not be able to
demonstrate cost-effectiveness even at a zero price for
the add-on therapy. This is because clinically effective
combination therapies are administered until the disease
progresses, so if the combination improves progressionfree survival and delays the progression, it will lengthen
the duration of both the backbone and add-on
treatment. So even if the add-on therapy itself has no
incremental cost, the treatment’s total cost will increase
due to the longer treatment duration.
Potential solutions to the combination pricing challenge
include:
VALUE ATTRIBUTION: Instead of taking the
price of the backbone therapy as a given,
its value should be allocated between the
backbone therapy and the add-on therapy.
INDICATION-SPECIFIC PRICING: The backbone
therapy’s price should have an indicationspecific price for the combination therapy,
ensuring pricing in other indications or its price
as a monotherapy remains the same as before.
Tripartite negotiations between manufacturers
and payer bodies are required where there are
different manufacturers of the elements of the
combination.
Although potential solutions exist, combination pricing
remains an awkward challenge.
EVERSANA Can Help
EVERSANA has rich experience in supporting clients
and developing potential solutions as they explore the
challenges of their combination therapy.
In a recent engagement, we helped a client understand
the complexities of pricing for their add-on therapy
which was being developed in combination with a
backbone therapy of another manufacturer. We also
helped them understand the range of price they can
expect in major markets including EU4, UK and the
U.S. based on a rigorous analysis and discussions with
payers and industry experts.
1 | © Copyright 2023 EVERSANA | EVERSANA.COM