Potential for Standardization in Economic Assessment Across HTA Bodies: A Case Study in First-Line Treatments of Non-Small Cell Lung Cancer

OBJECTIVES: With the introduction of EU Joint Clinical Assessment for first-indication oncology products from 2025, there is increasing focus on cross-border standardisation in HTA decision making. Standardisation is typically limited to clinical effectiveness and safety, given parameters for economic assessments can be country-specific, particularly costs and healthcare resource use (HCRU). This research aimed to investigate the potential for standardisation in economic assessment by examining influential sources of uncertainty in economic evaluations submitted in published technology appraisals (TAs).

METHODS: The NICE lung cancer guideline (NG122) was reviewed in May 2024 to identify published NICE TAs in untreated, advanced non-small cell lung cancer (NSCLC). Influential sources of uncertainty were identified from deterministic sensitivity analyses, scenarios, and feedback from external assessment groups. As an exploratory comparison, a subset of corresponding appraisals from CADTH and HAS were reviewed.

RESULTS: Of the NICE TAs identified (n=20), most utilised partitioned-survival models (n=17). Modelling overall survival (OS) was the most common uncertainty (n=15), including choice of extrapolation (n=11) and indirect treatment comparison method (n=4). Additional common uncertainties included utility (n=12), clinical parameters informing treatment costs (i.e. dose intensity and treatment duration) (n=10), and progression-free survival (PFS) (n=8). In HAS appraisals (n=4), OS extrapolations (n=4) and utilities (n=3) were key uncertainties. In CADTH appraisals (n=4), PFS (n=3), OS (n=2) and utility (n=2) were the most frequent uncertainties. Notably, unit costs and HCRU were not key uncertainties in any appraisals.

CONCLUSIONS: Across NSCLC TAs, clinical parameters informing economic assessment were consistently identified as influential sources of uncertainty, in particular modelling of long-term survival. Such parameters are typically derived from pivotal clinical trials or indirect treatment comparisons, which inform economic assessments across multiple HTA bodies. Country-specific cost and HCRU parameters were not commonly influential uncertainties. Standardising the appraisal of modelled clinical parameters may be feasible, and avoid duplication of effort across individual HTA bodies.