Proposal for a General Outcome-based Value Attribution Framework for Combination Therapies.

ABSTRACT

OBJECTIVE: Valuing and pricing the components of combination therapies can be difficult due to competition law issues, difficulty implementing different prices for the same product in alternative uses, and attributing value to each component of the combination. We propose a value attribution solution that allows all combination components to be priced according to their relative value in the combination. METHODS: We developed a value attribution solution that is universal, symmetrical, and neutral to each combination constituent, regardless of whether it is the backbone or the add-on; and complete, meaning it will always attribute the full value of the combination between the component parts. Moreover, it can be applied to any number of components in the combination (e.g. triplets or quadruplets). We compared this solution to two other existing approaches. RESULTS: The results of the proposed value attribution solution sit between those of the two other value attribution approaches as it combines elements of each. As the degree of additivity moves further away from one in either direction, then our general approach ratios also move, reflecting the impact of the incremental value. CONCLUSION: The proposed value attribution solution for combination therapies differs from two existing approaches by being universally applicable and allowing for symmetry when neutral to the constituent components of the combination. To optimally contribute to policy debate and practice, various requirements for its implementation need to be well understood including how to overcome (1) partial information, (2) whether its assumptions can be relaxed, and (3) implementation issues.