ABSTRACT

Background

Under current reimbursement (CR) practice even though an add-on drug in a combination therapy may produce marginal value in terms of health gain, the original therapy may also share in the reward for this additional value. We examine an alternative ‘marginal value-based reimbursement’ (MVBR) model in which an original therapy would not share in the marginal value.

Methods

In a case study for treatment of HER2+ metastatic breast cancer, we computed the incremental cost-effectiveness ratios (ICERs) of adding pertuzumab to trastuzumab and docetaxel (PHT) vs. trastuzumab and docetaxel (HT) under the CR and the MVBR models, respectively. We further estimated the revised cost of pertuzumab under three alternative willingness-to-pay thresholds based on (a) using the current ICER of PHT vs. HT, (b) the historical ICER of HT vs. docetaxel, and (c) applying the oft-used $150,000/quality-adjusted life year (QALY) gained.

Results

If reimbursement were changed from CR to MVBR, at the current price of pertuzumab, the ICER would decline from $409,213 to $323,236/QALY gained. If the price were adjusted under the three thresholds, the payment for pertuzumab would be increased by between 32% and 93%.

Conclusion

The proposed MVBR model would provide a stronger economic incentive to develop add-on drugs.

中文翻译：

---

联合治疗中基于价值定价的挑战：曲妥珠单抗和帕妥珠单抗治疗 HER2+ 转移性乳腺癌的案例

摘要

背景

在当前的报销 (CR) 实践下，即使联合疗法中的附加药物可能会在健康收益方面产生边际价值，原始疗法也可能分享这种额外价值的回报。我们研究了另一种“基于边际价值的报销”（MVBR）模型，其中原始疗法不会分享边际价值。

方法

在一项治疗 HER2+ 转移性乳腺癌的案例研究中，我们分别计算了在 CR 和 MVBR 模型下将帕妥珠单抗添加到曲妥珠单抗和多西他赛 (PHT) 与曲妥珠单抗和多西他赛 (HT) 的增量成本效益比 (ICER) . 我们根据 (a) 使用 PHT 与 HT 的当前 ICER，(b) HT 与多西他赛的历史 ICER，以及 (c) 应用获得了经常使用的 150,000 美元/质量调整生命年 (QALY)。

结果

如果报销从 CR 改为 MVBR，按照帕妥珠单抗的当前价格，ICER 将从 409,213 美元下降到 323,236 美元/QALY。如果在三个门槛下调整价格，帕妥珠单抗的支付将增加 32% 至 93%。

结论

提议的 MVBR 模型将为开发附加药物提供更强的经济激励。