Simulated Treatment Comparisons in NICE Technology Appraisals: Frequency Trends and Implications
Author(s)
Hannah E. Broster, BSc, MPH, Thomas Douglas, BSc, Andrew Clark, PhD, Kurt Taylor, PhD.
Petauri Evidence, Nottingham, United Kingdom.
Petauri Evidence, Nottingham, United Kingdom.
OBJECTIVES: Simulated treatment comparison (STC) is a pairwise population-adjusted indirect treatment comparison methodology used when head-to-head trials are unavailable. The National Institute for Health and Care Excellence (NICE) published an update to Technical Support Document 18 in 2020, discouraging matching-adjusted indirect comparisons (MAICs) in favour of STC for anchored and, under strict assumptions, unanchored comparisons. A prior review of submissions (April 2020 to June 2023) identified four submissions including STCs, compared with 36 including MAICs. This updated review examines NICE submissions from June 2023 to understand whether STC adoption has increased and reasons for its implementation in practice.
METHODS: NICE Technology Appraisal (TA) guidance committee papers published between 7th June 2023 to 4th June 2025 were reviewed, assessing how frequently STCs and MAICs appeared in submissions, and determining whether these were anchored or unanchored. Additionally, a targeted literature search was conducted to identify recent methodological developments in STC.
RESULTS: Since 7th June 2023, 185 TAs have been published, with only four submissions including STCs compared with 40 MAICs. All four STC submissions were unanchored and also included a MAIC. In two submissions, STC was used as the base case analysis; the remaining two were conducted as a sensitivity analysis. Since the previous review, use of STC in the base case has increased (from zero to two), though it remains infrequent relative to MAIC. Several methodological developments in STC were identified, including a novel unanchored approach that utilises standardisation and the NORTA algorithm to avoid aggregation bias.
CONCLUSIONS: Despite recent methodological advances and guidance favouring STC over MAIC in appropriate scenarios, adoption in NICE TA submissions remains limited. The continued predominance of MAIC suggests a gap between methodological recommendations and practical implementation. This highlights the need for further efforts to support uptake of STC, including a better understanding of barriers to its use.
METHODS: NICE Technology Appraisal (TA) guidance committee papers published between 7th June 2023 to 4th June 2025 were reviewed, assessing how frequently STCs and MAICs appeared in submissions, and determining whether these were anchored or unanchored. Additionally, a targeted literature search was conducted to identify recent methodological developments in STC.
RESULTS: Since 7th June 2023, 185 TAs have been published, with only four submissions including STCs compared with 40 MAICs. All four STC submissions were unanchored and also included a MAIC. In two submissions, STC was used as the base case analysis; the remaining two were conducted as a sensitivity analysis. Since the previous review, use of STC in the base case has increased (from zero to two), though it remains infrequent relative to MAIC. Several methodological developments in STC were identified, including a novel unanchored approach that utilises standardisation and the NORTA algorithm to avoid aggregation bias.
CONCLUSIONS: Despite recent methodological advances and guidance favouring STC over MAIC in appropriate scenarios, adoption in NICE TA submissions remains limited. The continued predominance of MAIC suggests a gap between methodological recommendations and practical implementation. This highlights the need for further efforts to support uptake of STC, including a better understanding of barriers to its use.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA299
Topic
Health Technology Assessment, Study Approaches
Disease
No Additional Disease & Conditions/Specialized Treatment Areas