Combination Oncologics: A Boon or Burden to Healthcare Systems?

Abstract

A 3 4 7 -A 7 6 6 A759 combination-oncologics. Methods: We reviewed two combination-oncologics currently available (Yervoy-Opdivo and Cotellic-Zelboraf) using a structured, value assessment framework that considers clinical performance, price and access metrics (for the US and UK). We also reviewed the combination-oncologic pipeline, and trends in Payer management to assess key indicators for access going forward. The research was conducted using evidence from peer-reviewed literature, business journals, manufacturer websites and press-releases. Results: Investment is growing, with > 400 industry sponsored trials listed for cancer immunotherapies in adults. The two cases exhibited considerable clinical benefit of combination, the Yervoy-Opdivo combination (versus Yervoy-monotherapy) resulted in tumor shrinkage in 60% (versus 11%), and PFS of 8.9 months (versus 4.7 months), while Cotellic-Zellboraf provided a median PFS of 12.3 months (versus 7.2 months for Zelboraf monotherapy). Estimated annual list price of Yervoy-Opdivo may exceed $295,000 (US annual list prices were $135,179 (Yervoy-monotherapy) and $142,300 (Opdivo-monotherapy)); while Cotellic-Zellboraf may approach $200,000 (individual US list prices were $72,741 (Cotellic-monotherapy) and $123,957 (Zellborafmonotherapy). US managed care organizations have reacted -Aetna and Anthem have implemented pilot projects incentivizing physicians for choosing preferred clinical treatment pathways. In the UK, Yervoy-Opdivo received a swift, yet positive, NICE appraisal (post 30% price mark-down to US, and additional, confidential discounts), while Cotellic-Zellboraf was not approved due to lack of cost-effectiveness data. ConClusions: A burgeoning clinical trial pipeline, considerable budget impact, and an increased need for effective disease management to alleviate morbidity and mortality, is bound to result in Payer control of access through existing (price discounts, precertification, patient cost burden), and innovative channels. Policies and market access strategies will increasingly need to account for budget impact, affordability, cost burden on patients, and increasing evidence requirements for access. PCN282GeoGraPhiC, raCial, aNd TemPoral VariaTioNs of adhereNCe To sCreeNiNG for CerViCal CaNCer aNd hPV VaCCiNaTioN iN The UNiTed sTaTes,