OBJECTIVES: In 2024 the UK Government published a prioritisation statement supporting improved cooperation between competing drug firms in relation to commercial negotiations for combination therapies¹. This research aims to highlight example cases where branded oncology combination therapies have been appraised by NICE, and the extent to which there has been a lack of transparency in commercial agreements which may have impacted the approval of effective treatments.

METHODS: A review was conducted to identify NICE appraisals of branded combination therapies over the 10-years between May 2014 and April 2024. A range of information was extracted relating to the timing, underlying evidence, uncertainty and outcomes. Appraisals were compared in order to understand how challenges with cooperation and transparency in drug pricing may have impacted the recommendations made.

RESULTS: The review identified a total of 665 Single Technology Appraisals. Once terminated, withdrawn and duplicate appraisals (with updated guidance) were removed, a final sample of n=482 remained, of which 251 were in an oncology setting. 29 considered branded combination therapies, all of which included a proposed confidential discount for multiple components of the combination. A total of 16 combinations included components marketed by different manufacturers, limiting the ability of companies to have full visibility on pricing and subsequently restricting the ability to interpret cost-effectiveness estimates of the combination medicine.

CONCLUSIONS: Results indicated that 86.2% of branded combinations were recommended either for routine use or with restrictions, slightly lower than the 88.7% for all other oncology appraisals. There has been a large increase in the number of combination medicines in recent years (21 of 29 STAs identified were published since 2020), with the number likely to increase in the future. More collaborative negotiations on price may be of notable importance moving forward to avoid limiting access to promising combination regimens.