OBJECTIVES:

Market saturation or commoditisation is an increasingly frequent occurrence in the healthcare industry, and brings with it the challenge of value differentiation. The aim of this research was to analyse value differentiation strategies utilised by a selection of case studies in saturated oncology therapy areas.

METHODS:

In-depth analysis of national HTA decisions was undertaken for selected oncology case studies in France, Germany, and England; these included novel therapies recently approved in relapsed / refractory multiple myeloma (RRMM), advanced melanoma, and non-small cell lung cancer (NSCLC), which have encountered an influx of novel products over the last five years. Descriptive analysis identified key decision drivers behind each appraisal, and an assessment of successful value differentiation strategies was also conducted.

RESULTS:

Despite perceived ‘market saturation’, most HTA decisions reviewed in RRMM, advanced melanoma and ALK+ NSCLC were ultimately positive (11/11, 9/11 and 5/6, respectively). While efficacy / safety outcomes are key decision-drivers in all HTA appraisals, they were the only drivers cited in FRA / GER appraisals, while NICE appraisals also cited cost-effectiveness, end-of-life criteria and treatment variety. Regardless of decision-drivers cited within appraisals, notable value differentiation strategies were employed by manufacturers to ensure a successful outcome. In RRMM, fixed drug combinations were a key differentiation strategy implemented, with KYPROLIS^TM (carfilzomib, AMGEN) seeking approval for a doublet combination in cost-effectiveness markets (ENG) and a triplet combination in clinical-effectiveness markets (FRA / GER). This method was also observed in advanced melanoma with success of the OPDIVO^TM / YERVOY^TM (nivolumab / ipilimumab, BMS) combination in ENG. Additional value differentiation strategies employed by manufacturers included mechanism of action and mode of administration.

CONCLUSIONS:

HTA bodies in FRA, GER and ENG remain receptive to novel therapies in saturated therapy areas. However, alternative value differentiation strategies can and have been employed to improve market access success in these scenarios.