REAL-TERMS DEPRECIATION OF WILLINGNESS-TO-PAY THRESHOLDS FOR DOUBLE-BRANDED ONCOLOGY COMBINATIONS ACROSS HTA MARKETS, 2015-2025
Author(s)
Jeroen Paulissen, PhD1, Madeleine Hamilton, BSc2, Ruodan Nan, PhD2, Savita Sundaresan, PhD2, Innocent Pfaira, MSc3.
1Daiichi Sankyo Nederland, Schiphol Rijk, Netherlands, 2Access Infinity, London, United Kingdom, 3AstraZeneca, Cambridge, United Kingdom.
1Daiichi Sankyo Nederland, Schiphol Rijk, Netherlands, 2Access Infinity, London, United Kingdom, 3AstraZeneca, Cambridge, United Kingdom.
OBJECTIVES: Willingness-to-pay (WTP) thresholds are central to cost-effectiveness assessments in health technology assessment (HTA), yet their inflation-adjusted evolution relative to broader macroeconomic and health cost growth remains poorly characterised. We aimed to quantify WTP threshold trends for double-branded oncology combinations (regimens combining two on-patent therapies, with no generic or biosimilar component) and to compare them with macroeconomic and healthcare-cost indicators across HTA markets, 2015-2025.
METHODS: A structured analogue review identified 251 HTA assessments of 18 non-orphan, double-branded solid-tumour oncology combinations across 22 indications in 17 markets (Europe, North America, Asia-Pacific). Implicit thresholds were inferred from ICER acceptance/rejection pattern. Public perceptions for acceptance ceilings were excluded. WTP trends were benchmarked against six indicators: GDP per capita, general consumer price index (CPI), health CPI, health expenditure per capita, medical-goods spending, and average cost per hospital discharge - sourced from World Bank, OECD, IMF, and Our World in Data. All trends were deflated using country-specific general CPI, indexed to 2015=100, and compared using linear regression.
RESULTS: Across all markets with sufficient longitudinal data, nominal WTP thresholds were largely static. After adjusting for general CPI, real-terms WTP declined in every analysable market. The real-term decline of WTP was more significant if compared to growths in GDP per capita, health expenditure per capita and average cost per hospital discharge since 2015.
CONCLUSIONS: Although restricted to WTP thresholds and not the wider set of payer decision drivers (e.g., budget impact, opportunity cost), the real-terms WTP thresholds for double-branded oncology combinations have depreciated across all analysable HTA markets over 2015-2025, and did not keep pace with growth in GDP, general CPI, healthcare spending and hospital-cost. Static nominal thresholds therefore imply a year-on-year tightening of HTA decision rules and warrant explicit consideration in threshold-setting methodology and periodic recalibration.
METHODS: A structured analogue review identified 251 HTA assessments of 18 non-orphan, double-branded solid-tumour oncology combinations across 22 indications in 17 markets (Europe, North America, Asia-Pacific). Implicit thresholds were inferred from ICER acceptance/rejection pattern. Public perceptions for acceptance ceilings were excluded. WTP trends were benchmarked against six indicators: GDP per capita, general consumer price index (CPI), health CPI, health expenditure per capita, medical-goods spending, and average cost per hospital discharge - sourced from World Bank, OECD, IMF, and Our World in Data. All trends were deflated using country-specific general CPI, indexed to 2015=100, and compared using linear regression.
RESULTS: Across all markets with sufficient longitudinal data, nominal WTP thresholds were largely static. After adjusting for general CPI, real-terms WTP declined in every analysable market. The real-term decline of WTP was more significant if compared to growths in GDP per capita, health expenditure per capita and average cost per hospital discharge since 2015.
CONCLUSIONS: Although restricted to WTP thresholds and not the wider set of payer decision drivers (e.g., budget impact, opportunity cost), the real-terms WTP thresholds for double-branded oncology combinations have depreciated across all analysable HTA markets over 2015-2025, and did not keep pace with growth in GDP, general CPI, healthcare spending and hospital-cost. Static nominal thresholds therefore imply a year-on-year tightening of HTA decision rules and warrant explicit consideration in threshold-setting methodology and periodic recalibration.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE529
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Thresholds & Opportunity Cost
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology