13 - Smart People: Fleur Chandler

What are combination therapies and how can they improve outcomes for cancer patients?
Combination therapies are becoming increasingly commonplace and are seen to be the future of oncology treatment. These are two or more treatments used together to target multiple pathways involved in the complex pathophysiology of cancer.1, 2 This method may help to make them more effective at reducing drug resistance.1,2
Over the past few decades, new treatments have extended survival for cancer patients3 and improved prognosis considerably, which is good news for patients.1 Despite these advances, significant unmet needs in many cancers still sadly exist.

What challenges exist in securing patient access to combination therapies in the UK?
A key challenge faced is that UK frameworks are not equipped to recognise the value that a longer time to disease progression, and increased quality of life, can bring for a patient treated with a combination.1 This is because cost-effectiveness assessment is based on the overall cost of the combination and does not establish a value-based price for each component. In most cases, the combination is derived from the addition of a ‘new’ therapy to an already approved mono-therapeutic option.1 In extreme cases, today’s frameworks can lead to outcomes whereby the combination offers clear benefits but is not considered cost-effective, even if the additional therapy is priced at zero.4

Compounding this further is the fact that products cannot be priced differently, whether they are used as a monotherapy or in combination – once a price is agreed, it must be applied to all uses of that medicine.1

With hundreds of clinical trials underway for combination cancer treatments5 and combinations becoming the standard of care, NHS England and NICE must adapt to effectively and fairly evaluate these treatments.

How can the value assessment of combination therapies be improved to ensure fair and sustained access to combination therapies?
At Sanofi, our goal is to support positive, fair, and efficient pricing and reimbursement frameworks, which allow for the financing of combination products while enabling patient access, sustainable health system expenditure and rewarding innovation.

To achieve this, pricing and reimbursement systems need to be reformed. Companies need to feel secure that they are not breaching competition law by entering into agreement with the manufacturer of the combination partner.

One way we believe this can be resolved is through an assessment methodology that allows products to be priced according to their relative contribution to the benefit of the overall treatment. Value can then be fairly shared between companies owning the combination products and more importantly, treatments reach patients more quickly.

The introduction of indication-based pricing is also a priority. Offering the ability to price products differently based on patient value and whether they are used as monotherapy or in combination would help to ease negotiations between multiple manufacturers, as a lower product price in combination would not have an impact on the price of other therapeutic indications.

By addressing these key areas, we will be able to ensure that innovations are quicker to reach those that need it most.

References
1. OECD, Addressing Challenges in Access to Oncology Medicines, 2020. Available at: https://ec.europa.eu/health/sites/health/files/policies/docs/access_oncologymedicines_rep_web_en.pdf (Accessed April 2021).
2. Mokhtari et al, Combination therapy in combating cancer, Oncotarget. 2017 Jun 6; 8(23): 38022–38043. Published online 2017 Mar 30. doi: 10.18632/oncotarget.16723.
3. National Cancer Institute, SEER Cancer Statistics Review (CSR) 1975-32017. Available at: https://seer.cancer.gov/csr/1975_2017/ (Accessed April 2021).
4. Davis, S. Assessing technologies that are not cost-effective at zero price - Report by the Decision Support Unit. (2014).
5. EU Clinical Trials Register. Clinical trials for combination. Available at: https://www.clinicaltrialsregister.eu/ctr-search/search?query=combination&country=gb&status=ongoing (Accessed April 2021).

SMART PEOPLE:Fleur Chandler

SMART PEOPLE:
Fleur Chandler