Presentation (CTI)

OBJECTIVES: In England, the National Institute for Health and Care Excellence (NICE) make reimbursement recommendations based on the clinical and cost-effectiveness of new health technologies. An External Assessment Group critically appraises each manufacturer submission and raises ‘key issues’ of potential importance for decision making. Costs are a key driver of cost-effectiveness outcomes; however, they seldom receive as much focus as other components of the appraisal. This study evaluates the emphasis on ‘key issues’ related to costs within NICE submissions of interventions for non-small-cell lung cancer (NSCLC).
METHODS: A literature review was conducted to identify technology appraisals in NSCLC published in the past 5 years. The analysis identified the proportion of key issues related to cost (compared with other components such as the decision problem, clinical effectiveness, or health-related quality of life). Key issues related to costs were reviewed and categorized into recurring themes.
RESULTS: Thirty technology appraisals in NSCLC published since December 2019 were identified. Of these, 5 were terminated, leaving 25 for inclusion in the analysis. In total, 234 key issues were identified; 127 of which were related to the cost-effectiveness evidence. Of these, 35 key issues were directly relating to costs (equating to 15% of all key issues, or 28% of the cost-effectiveness key issues). Of the key issues related to costs, time-to-treatment discontinuation (TTD), subsequent treatment, and relative dose intensity (RDI) emerged as consistent themes.
CONCLUSIONS: Although costs are a determinant of cost-effectiveness outcomes, they appear to receive less scrutiny in health technology assessment compared with other elements of the submission, based on a review of NSCLC appraisals. However, clearer guidance on appropriate assumptions when modelling TTD (particularly in the absence of reported data), subsequent treatments (especially within a partitioned survival modelling framework), and RDI (when calculating drug costs) could improve the robustness of, and consistency between, economic evaluations.