Introduction

The increasing use of combination therapies, particularly in oncology, has brought substantial benefits to patients but also significant complexities for health technology assessment (HTA). One of the most pressing challenges is the attribution of value—and consequently pricing—to individual components of combination treatments, especially when they originate from different manufacturers.

Two Proposed Solutions, One Common Objective

In the January 2025 issue of Value in Health, two frameworks were independently proposed to address the value attribution challenge:

• Attribution of Value Framework for Combination Treatments
• Outcome-Based Value Attribution Framework

While at first glance these frameworks may appear distinct, a deeper analysis reveals that their similarities significantly outweigh their differences. Both approaches share the fundamental objective of systematically attributing value between components based on clear and transparent principles, ensuring fair pricing and equitable access to effective therapies.

Common elements include:

• Emphasis on clear and transparent criteria for value distribution.
• Use of quantitative health outcomes (e.g., QALYs) as a neutral metric for attribution.
• Recognition of the critical importance of cooperation between stakeholders.

These similarities suggest a convergence in thinking among HTA researchers, highlighting a robust consensus on foundational principles.

Editorial Insights and the Real-World Implementation Challenge

The accompanying editorial by Oriana Ciani and Claudio Jommi [link to editorial] further underscores that the core theoretical issue of value attribution may now be effectively resolved. They stress that the most significant remaining challenge lies not in conceptual disagreements, but rather in practical implementation.

HTA bodies must now lead efforts to address the implementation hurdles. These include:

• Developing standardised guidelines for negotiations between manufacturers.
• Ensuring consistent application of frameworks across different treatment contexts.
• Facilitating collaborative data-sharing practices that underpin effective attribution.

A Call to Action for HTA Bodies

With the theoretical basis now solidified by two independently developed yet remarkably aligned frameworks, it is incumbent upon HTA bodies and policymakers to step forward. Solving practical issues around implementation is crucial to ensuring that the potential benefits of these frameworks translate into real-world outcomes, ultimately improving patient access to innovative combination therapies.

Conclusion

The convergence in approaches to value attribution for combination therapies marks significant progress. Now, addressing practical implementation challenges must become a priority. Collaborative efforts by HTA bodies, industry, and policymakers will be vital to overcoming these final hurdles and delivering equitable, effective treatments to patients.