Subsequent Treatments and NICE Appraisals for DLBCL: A Review of Committee Discussions
Author(s)
Elizabeth Thurgar1, Rob Blissett, EngD2, Nathaniel Smith, PhD3.
1Health Economist, Maple Health Group, New York, NY, USA, 2Maple Health Group, Winchester, United Kingdom, 3Maple Health Group, LLC, New York, NY, USA.
1Health Economist, Maple Health Group, New York, NY, USA, 2Maple Health Group, Winchester, United Kingdom, 3Maple Health Group, LLC, New York, NY, USA.
OBJECTIVES: The treatment landscape for diffuse large B-cell lymphoma (DLBCL) is changing rapidly. Subsequent treatments included in clinical trials may become outdated, affecting generalisability of results to clinical practice.
The objectives of this analysis were to review National Institute for Health and Care Excellence (NICE) appraisals of DLBCL treatments and assess: which appraisals identified modelling of subsequent treatments as a key issue, the concerns raised, and the preferred modelling approach noted by committees.
METHODS: The NICE website was searched to identify appraisals of treatments for DLBCL. Public committee slide decks were reviewed and, for appraisals in which subsequent treatments were raised as a key issue, information on the issue and preferred approach by the Company, Evidence Assessment Group (EAG) and committee were extracted.
RESULTS: Ten appraisals were identified; one (TA933) was terminated. Of the remaining nine, five appraisals included subsequent treatments as a key issue. In four of these, the impact on model results was considered “large.”
The key issue raised across appraisals for subsequent treatments was the generalisability of subsequent treatments included in relevant clinical trials to clinical practice. For TA874 and TA895, subsequent treatments which were not routinely commissioned but available within the Cancer Drug Fund (CDF) were not considered appropriate for inclusion in the modelling. For TA947, TA954 and TA1048, the mix of subsequent treatments received in clinical practice was uncertain.
All appraisals considered the impact of subsequent treatments on cost. Three appraisals considered the impact on outcomes; however, only one appraisal (TA895) incorporated formal methods to adjust estimates of survival.
CONCLUSIONS: Subsequent treatments are a recurring concern in NICE appraisals for DLBCL. While the impact on costs is frequently considered, formal methods to adjust for treatment mix on outcomes are less commonly applied. Clearer guidance may be needed to support consistent modelling of subsequent treatments in appraisals.
The objectives of this analysis were to review National Institute for Health and Care Excellence (NICE) appraisals of DLBCL treatments and assess: which appraisals identified modelling of subsequent treatments as a key issue, the concerns raised, and the preferred modelling approach noted by committees.
METHODS: The NICE website was searched to identify appraisals of treatments for DLBCL. Public committee slide decks were reviewed and, for appraisals in which subsequent treatments were raised as a key issue, information on the issue and preferred approach by the Company, Evidence Assessment Group (EAG) and committee were extracted.
RESULTS: Ten appraisals were identified; one (TA933) was terminated. Of the remaining nine, five appraisals included subsequent treatments as a key issue. In four of these, the impact on model results was considered “large.”
The key issue raised across appraisals for subsequent treatments was the generalisability of subsequent treatments included in relevant clinical trials to clinical practice. For TA874 and TA895, subsequent treatments which were not routinely commissioned but available within the Cancer Drug Fund (CDF) were not considered appropriate for inclusion in the modelling. For TA947, TA954 and TA1048, the mix of subsequent treatments received in clinical practice was uncertain.
All appraisals considered the impact of subsequent treatments on cost. Three appraisals considered the impact on outcomes; however, only one appraisal (TA895) incorporated formal methods to adjust estimates of survival.
CONCLUSIONS: Subsequent treatments are a recurring concern in NICE appraisals for DLBCL. While the impact on costs is frequently considered, formal methods to adjust for treatment mix on outcomes are less commonly applied. Clearer guidance may be needed to support consistent modelling of subsequent treatments in appraisals.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA304
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Topic Subcategory
Decision & Deliberative Processes
Disease
Oncology