Measuring Impact of HTA on Patient Access to New Medicines in NHS England: A Comparison of Public Health Insurance Funding Restrictions and Patient Uptake for New Medicines across England, France, Germany, and the United States

OBJECTIVES: In England, the National Institute for Health and Care Excellence (NICE) recommends whether a new medicine should be funded in the National Health Service (NHS) by performing health technology assessment (HTA). Patients in NHS England face access restrictions to new medicines not only when negative recommendations by NICE prevent funding, but also (and more frequently) when NICE gives an ‘optimized’ recommendation for only some of a medicine’s approved patient population. This study measures the impact of HTA on patient access to new medicines in NHS England by comparing public health insurance funding restrictions and patient uptake for new medicines across England, France, Germany, and the United States.

METHODS: NICE guidance were compared to EMA/MHRA marketing authorization to identify access restrictions in NHS England for all new medicines launched globally between 2017-2023. Access restrictions were similarly identified for France’s Statutory Health Insurance (SHI) using recommendations by the French National Authority for Health (HAS). Uptake rates for new medicines were estimated on a per capita basis for each of the four countries, using data on volume, treatment duration, and adherence.

RESULTS: Patients in NHS England face access restrictions on 66% of NICE recommended new medicines compared to 41% of HAS recommended new medicines in France’s SHI. Uptake rates across all new medicines covered in NHS England are 14% lower than France, 47% lower than Germany, and 81% lower than the United States.

CONCLUSIONS: HTA negatively impacts patient access in NHS England. Patients in England face access restrictions on a greater number of new medicines than patients in France, Germany, and the United States, and the uptake of new medicines, particularly in cancer treatment, are reduced by NICE ‘optimized’ recommendations.