OBJECTIVES: In recent years branded combination oncology regimens have become more prevalent and expensive. This analysis aims to understand how product characteristics and unmet need influence pricing for combination therapies.

METHODS: This study focused on recently approved and evaluated combination oncology therapies (N=7); we used European HTAs to inform selection criteria. We identified product characteristics, unmet need, number of competitors and ownership dynamics as key pricing considerations. We calculated costs as cost/course and cost/month in USD. This analysis included the US, France, Germany, Italy, Spain, UK, and Japan.

RESULTS: Clinical characteristics of combination oncology regimens have the greatest impact on payers’ willingness to pay (WTP). Higher median progression-free survival (mPFS) was associated with higher combination prices. Carfilzomib and lenalidomide (multiple myeloma) attained the highest mPFS of 26.3 months among included combinations, and had the highest global cost/course of $390,920. In contrast, fulvestrant and palbociclib (breast cancer) had 9.5 months mPFS and the lowest price, $87,627. Combination regimens initially targeting smaller patient populations were also associated with higher prices. This is particularly true in the US, where everolimus and lenvatinib achieved a price in renal cell carcinoma that was 5-6 times higher vs. other markets, largely driven by initial launch in a smaller indication (differentiated thyroid cancer).

CONCLUSIONS: Payers will continue to look for larger improvements in clinical efficacy to justify increasingly expensive combinations in oncology – while OS data is preferred, favorable PFS data is sufficient to achieve high prices. Lower incidence of disease and smaller patient populations will also increase payers’ WTP. Given the expanding pipeline of combination oncology regimens, these factors will continue to play an increasingly important role in the evaluation and pricing of combination therapies.