OBJECTIVES:

Combination therapies are increasingly becoming the standard of care in oncology, with more than 300 active clinical trials for combination therapies currently in progress in the UK alone. The aim of the project is to contextualise the value of combination therapies against the background of National Institute for Health and Care Excellence (NICE) frameworks relying on cost effectiveness modelling in their decision-making processes.

METHODS:

A review of NICE health technology assessments (HTAs) involving combination oncology therapies was conducted. All published HTAs for combination therapies between January 2017 – June 2022 were included. Terminated appraisals were not excluded. NICE appraisal outcomes, number of appraisal committee meetings and key drivers of cost-effectiveness a) disease progression, b) overall survival, c) health related quality of life (HRQoL) and d) costs were reviewed.

RESULTS:

Benefits of combination therapies were mainly captured in measures of disease progression and HRQoL. Among the 65 NICE submissions, a majority (n=42) submissions were price optimised, with 40% of these also receiving an optimised recommendation in the indication. Of the were terminated appraisals (n=21), a majority (n=13) were in advanced or metastatic disease indication.

CONCLUSIONS:

There is evidence of positive impact of combination therapies in oncology on patient lives. When therapies are indicated for treatment until progression, costs of care are heightened and are further magnified when considering combinations of two or more branded treatments. The current framework of health technology assessments lead to treatments being heavily discounted to meet the cost effectiveness thresholds. We can infer that demonstrating cost-effectiveness for any add-on therapies would be challenging and potentially limiting access. This has significant implication for patients with advanced disease needing complex treatment regimens. Greater flexibility in methods is needed such that UK HTA processes don’t fall behind in terms of outcomes, patient access and incentives to future research into combinations.