An Attribution of Value Framework for Combination Treatments.

Autor: Briggs AH; London School of Hygiene and Tropical Medicine, London, UK; Avalon Health Economics, Morristown, NJ, USA. Electronic address: andrew.briggs@lshtm.ac.uk., Doyle-Connolly A; Avalon Health Economics, Morristown, NJ, USA., Schneider J; Avalon Health Economics, Morristown, NJ, USA., Podkonjak T; Takeda Pharmaceuticals International AG, Zurich, Switzerland., Taylor H; Takeda UK Ltd, London, UK., Roffe E; Takeda UK Ltd, London, UK., Low E; Eric Low Consulting, Edinburgh, UK., Davis S; University of Sheffield, Sheffield, UK., Kaiser M; Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK., Hatswell AJ; Delta Hat, Nottingham, UK., Rabin N; University College Hospital, London, UK.
Jazyk: angličtina
Zdroj: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research [Value Health] 2024 Oct 29. Date of Electronic Publication: 2024 Oct 29.
DOI: 10.1016/j.jval.2024.08.012
Abstrakt: Objectives: The use of cost-effectiveness methods to support policy decisions has become well established, but difficulties can arise when evaluating a new treatment that is indicated to be used in combination with an established backbone treatment. If the latter has been priced close to the decision maker's willingness-to-pay threshold, this may mean that there is no headroom for the new treatment to demonstrate value, at any price, even if the combination is clinically effective. Without a mechanism for attributing value to component treatments within a combination therapy, the health system risks generating negative funding decisions for combinations of proven clinical benefit to patients. The aim of this work was to define a value attribution methodology, which could be used to allocate value between the components of any combination treatment.
Methods: The framework is grounded in the standard decision rules of cost-effectiveness analysis and provides solutions according to key features of the problem: perfect/imperfect information about component treatment monotherapy effects and balanced/unbalanced market power between their manufacturers.
Results: The share of incremental value varies depending on whether there is perfect/imperfect information and balance/imbalance of market power, with some scenarios requiring the manufacturers to negotiate a share of the incremental value within a range defined by the framework.
Conclusions: It is possible to define a framework that is independent of price and focuses on benefits expressed as quality-adjusted life-year gains (and/or quality-adjusted life-year equivalents for cost savings), a standard metric used by many health technology assessment agencies to evaluate novel treatments.
Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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