, London, UK.
Ideas & Solutions, H1114, Vásárhelyi Pál u. 7. II. em. 9, Budapest, Hungary.
Appl Health Econ Health Policy. 2023 Jul;21(4):537-546. doi: 10.1007/s40258-023-00795-8. Epub 2023 Mar 10.
Combinations of on-patent therapies (CTs) are increasingly common in oncology. They cause challenges for funding and affordability, and hence patient access, especially when constituent therapies are owned by different manufacturers. The aim of our study was to develop policy proposals for the assessment, pricing, and funding of CTs and identify which might be relevant in different European countries.
Following a review of available literature, seven hypothetical policy proposals were developed and subsequently assessed through 19 semi-structured interviews with health policy, pricing, technology assessment and legal experts in seven European countries to identify those most likely to gain traction.
Experts saw a need for agreed approaches within a country to manage affordability and funding challenges for CTs. Changes to health technology assessment (HTA) and funding models were considered unlikely, but other policy proposals were seen as mostly useful, with country-specific adaptations. Bilateral discussions between manufacturers and payers were deemed important, and less challenging and protracted than arbitrated dialogue between manufacturers. Usage-specific pricing, possibly using weighted average prices, was considered a prerequisite for the financial management of CTs.
There is a growing need to ensure that CTs are affordable to health systems. It would appear that there is no one set of policies that is appropriate for all countries in Europe, so countries wishing to ensure that patients have (or continue to have) access to CTs of value to them must explore and implement the policies that are best suited to their general approach to funding health care and to the assessment and reimbursement of medicines.
联合专利疗法（CTs）在肿瘤学中越来越常见。它们给资金和负担能力带来了挑战，因此也给患者获得治疗的机会带来了挑战，尤其是当组成疗法由不同的制造商拥有时。我们研究的目的是为 CTs 的评估、定价和资金提供制定政策建议，并确定哪些建议可能在不同的欧洲国家具有相关性。
在对现有文献进行审查后，制定了七个假设性政策建议，并随后通过在七个欧洲国家与卫生政策、定价、技术评估和法律专家进行的 19 次半结构化访谈对这些建议进行评估，以确定最有可能被采纳的建议。
专家认为需要在一个国家内部达成一致的方法来管理 CTs 的负担能力和资金挑战。对卫生技术评估（HTA）和资金模式的改变被认为不太可能，但其他政策建议被认为是大多数有用的，需要根据具体国家进行调整。制造商和支付方之间的双边讨论被认为很重要，而且比制造商之间的仲裁对话更简单和耗时。特定用途的定价，可能使用加权平均价格，被认为是 CT 财务管理的前提。
越来越有必要确保医疗保健系统能够负担得起 CTs。似乎没有一套适用于欧洲所有国家的政策，因此，希望确保患者能够（或继续能够）获得对他们有价值的 CTs 的国家必须探索和实施最适合其总体资金筹措方法的政策对医疗保健的评估和报销药品。
