OBJECTIVES: Combining oncology therapies can produce more efficacious treatments by simultaneously targeting multiple pathways. However, their additive costs can pose significant challenges for payers. This is especially true for cost-effectiveness markets where some therapies used in combination have not demonstrated cost-effectiveness even if priced at zero cost! This research compares reimbursement outcomes of combination oncology products in cost-effectiveness (UK, NICE) versus clinical-effectiveness market archetype (France, HAS).

METHODS: Publicly-available information from the NICE database were screened to identify the reimbursement decisions for branded oncology combination products between 01-Jan-2017 and 30-April-2023. These decisions were cross-referenced with the respective TC evaluations from the HAS website.

RESULTS: A total of 28 branded combination oncology evaluations were identified; 6 where the same manufacturers made both components and 22 with different manufacturers. For same manufacturer combinations, NICE recommended 50%, restricted 17%, not recommended 17%, with 17% not submitted. HAS recommended 67%, restricted 17%, with 17% not assessed. For different manufacturer combinations, NICE recommended 9%, restricted 18%, CDF 32%, 9% not recommended, and 32% non-submissions. HAS reimbursed 64%, restricted 9%, not reimbursed 14% and 14% were not assessed. Thus, positive reimbursement decisions (defined as ‘recommended’ or 'recommended in CDF' for NICE and any SMR above ‘not sufficient’ for HAS) for same manufacturer combinations were 50% and 67% in the UK and France. By contrast, combinations with different manufacturers received positive decisions in 23% and 64% of UK and France appraisals, respectively.

CONCLUSIONS: The results illustrate that branded combination products have a higher positive decision rate in France versus the UK. Further, a substantially lower recommendation rate was observed for branded combination products of different manufacturers vs. same manufacturers in the UK but not in France. This can be potentially attributed to NICE’s evaluation being driven by cost-effectiveness whereas the HAS evaluation is purely focused on clinical benefit.