Role of Relative Dose Intensity in Health Economic Evaluations: A Review of National Institute for Health and Care Excellence Technology Appraisals of Treatments in Solid Tumors
Author(s)
Anandaroop Dasgupta, PhD1, Ankita Kaushik, PhD1, Shubhram Pandey, MSc2, Sumeet Attri, MPharm2, Paul Miller, BA, MSc, PhD3, Keith H. Tolley, BA, MPhil4;
1Gilead Sciences, Inc, Foster City, CA, USA, 2Pharmacoevidence, Mohali, India, 3Miller Economics Limited, Macclesfield, United Kingdom, 4Tolley Limited, Derbyshire, United Kingdom
1Gilead Sciences, Inc, Foster City, CA, USA, 2Pharmacoevidence, Mohali, India, 3Miller Economics Limited, Macclesfield, United Kingdom, 4Tolley Limited, Derbyshire, United Kingdom
Presentation Documents
OBJECTIVES: Relative dose intensity (RDI) is a ratio of actual dose delivered to planned dose. We examined the derivation and implications of incorporating RDI in economic evaluations of interventions across solid tumors including breast, renal, colorectal, urothelial, esophageal squamous cell cancers, and malignant pleural mesothelioma, published in National Institute for Health and Care Excellence (NICE) Technology Appraisals (TAs).
METHODS: The NICE website was manually searched for TAs (submissions, Evidence Review Group [ERG] appraisals, NICE appraisal committee (AC) decisions, and company responses) of treatments in solid tumors to evaluate the role of RDI in cost-effectiveness evaluations and decision-making by NICE.
RESULTS: RDI, including dose-reduction (DR) or dose-delay (DD), was reported across 19 of 63 identified TAs. RDI estimates (<100%) were available in 12 TAs. Nine TAs provided RDI calculation details, covering DD or missed dose (MD; TA865, 818, 788), DD+MD (TA530, 417), DR+treatment delay (TD; TA515, 423), DR+MD+TD (ID3935/GID-TA10813), and DR+DD+dose interruption (TA819). In 13 TAs, RDI was applied to treatment costs in base-case analysis. The ERG recommended excluding (TA819, 952, 417, 818) or changing the calculation of RDI (TA530, 865) if the derivation of RDI was not clear. In response to ERG comments, the submitter provided more rationale regarding feasibility of dropping RDI (TA819, 952) in cost-effectiveness analysis, or recalculated (TA417, 865) and applied RDI multipliers (TA417, 865) uniformly across the treatment arms. In all the adjustments done, NICE AC acknowledged RDI as one of the key drivers of cost-effectiveness ratio.
CONCLUSIONS: Past TAs have shown mixed results regarding derivation of RDI. Most of the TAs demonstrate RDI impacting costs in economic evaluations and therefore cost-effectiveness results. Hence, transparent, and accurate RDI calculation incorporating DD, MD, and/or DR would better reflect the comparison of true drug acquisition costs and help inform NICE the extent to which RDI can impact cost-effectiveness measure of oncology treatments.
METHODS: The NICE website was manually searched for TAs (submissions, Evidence Review Group [ERG] appraisals, NICE appraisal committee (AC) decisions, and company responses) of treatments in solid tumors to evaluate the role of RDI in cost-effectiveness evaluations and decision-making by NICE.
RESULTS: RDI, including dose-reduction (DR) or dose-delay (DD), was reported across 19 of 63 identified TAs. RDI estimates (<100%) were available in 12 TAs. Nine TAs provided RDI calculation details, covering DD or missed dose (MD; TA865, 818, 788), DD+MD (TA530, 417), DR+treatment delay (TD; TA515, 423), DR+MD+TD (ID3935/GID-TA10813), and DR+DD+dose interruption (TA819). In 13 TAs, RDI was applied to treatment costs in base-case analysis. The ERG recommended excluding (TA819, 952, 417, 818) or changing the calculation of RDI (TA530, 865) if the derivation of RDI was not clear. In response to ERG comments, the submitter provided more rationale regarding feasibility of dropping RDI (TA819, 952) in cost-effectiveness analysis, or recalculated (TA417, 865) and applied RDI multipliers (TA417, 865) uniformly across the treatment arms. In all the adjustments done, NICE AC acknowledged RDI as one of the key drivers of cost-effectiveness ratio.
CONCLUSIONS: Past TAs have shown mixed results regarding derivation of RDI. Most of the TAs demonstrate RDI impacting costs in economic evaluations and therefore cost-effectiveness results. Hence, transparent, and accurate RDI calculation incorporating DD, MD, and/or DR would better reflect the comparison of true drug acquisition costs and help inform NICE the extent to which RDI can impact cost-effectiveness measure of oncology treatments.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HTA2
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
SDC: Oncology