The International Impact of National Institute for Health and Care Excellence (NICE) Decisions

Speaker(s)

Brassel S1, Oliver E1, Henderson N2, O'Neill P1, Saeed FO3, Gibbons I4, Allen R5, Hudson R3, Malottki K6, Wentzel H3, Largeron N7, Garau M1
1Office of Health Economics, London, UK, 2Office of Health Economics, London, LON, UK, 3Sanofi, Reading, UK, 4Sanofi, BERKSHIRE, UK, 5Sanofi, Thames Ditton, SRY, UK, 6Sanofi, Reading, RDG, UK, 7sanofi, lyon, France

Presentation Documents

OBJECTIVES: To explore what effect, if any, NICE HTA (Health Technology Assessment) decisions have on the decisions made by other countries' HTA agencies.

METHODS: We constructed a dataset from 51 selected Drug Indication Pairs (DIPs), with a NICE decision published between 2018-2019. For each DIP, we retrieved information on NICE’s HTA process, outcomes and – where available – equivalent information from HTA bodies within Australia, Brazil, Canada, France, Italy, South Korea, Poland, and Sweden, resulting in 408 observations.

We first compared outcomes (positive - including fully recommended and optimised, and negative) and decision speeds. We then tested for categorical independence between outcomes of NICE and other HTA bodies using appropriate significance tests. We explored causality by creating dummy variables indicating whether NICE decided before another country’s HTA body. Finally, we tested the effect of negative decisions and terminated NICE appraisals when using un-coded NICE outcomes.

RESULTS: Compared to other countries in this sample, decisions in England were published early, potentially linked to the timing of submission. 90% of the decisions were positive or optimised. There was no significant relationship between decision outcomes on an aggregate level, irrespective of when NICE published its decision. Within a country subset (Poland, Italy, Korea, Sweden), a favorable decision was more likely when NICE published a favorable decision beforehand. However, the results were not significant.

Categorical NICE outcomes significantly relate (p-value: 0.0057) with other countries’ decisions when terminated appraisals were included: recommended and optimised NICE decisions were linked to positive outcomes, and negative NICE decisions (and terminated appraisals) were linked to missing HTA decisions.

CONCLUSIONS: A clear causal link between NICE decisions and decisions in other countries could not be established. Further research may explore the explicit impact of NICE’s decisions in specific countries and the wider, implicit impact of NICE methods on HTA systems internationally.

Code

HPR185

Topic

Health Policy & Regulatory

Topic Subcategory

Approval & Labeling, Reimbursement & Access Policy

Disease

No Additional Disease & Conditions/Specialized Treatment Areas