Cost-Comparisons, an Easier Route to NICE Recommendations?

OBJECTIVES: The number of appraisals published annually by the National Institute of Health and Care Excellence (NICE) has increased by 25% between 2017/18 and 2022/23. To ensure timely access to cost-effective treatments, NICE introduced the fast-track appraisal (FTA) process in April 2017, and limited this route to only cost-comparison (CC) analyses in February 2022. Our aim was to identify how many CC analyses have taken place, the type of clinical evidence submitted and the associated funding recommendations.

METHODS: We identified the TAs published by NICE undertaking the CC route between 2017 and 2023 and extracted information on the clinical evidence and funding recommendations.

RESULTS: Out of 426 published TAs since 2017, 23 used the CC route (17/23 via the FTA process). CC analysis was initially suggested by NICE in the scoping phase (16/23). All interventions were recommended with conditions: a simple discount (19/23), restricted patient population (18/23) or both (16/23). Overall, medicines undergoing the CC route showed similar clinical effectiveness (19/23), supported mainly by indirect treatment comparisons (ITCs) (21/23) and head-to-head evidence against one comparator (11/23). Head-to-head evidence demonstrated superiority for at least one outcome in 6/11 TAs. Twenty-one of 23 TAs reported similar or lower intervention costs versus alternative(s) and 17/21 achieved this with a price discount.

CONCLUSIONS: All TAs negotiated the CC route at the scoping phase and resulted in conditional recommendations supported by head-to-head and/or ITC evidence. To achieve similar or lower costs and obtain a positive recommendation, most manufacturers had to propose a price discount.