Presentation (CTI)

OBJECTIVES: The ISPOR ‘Value Flower’ was introduced in 2018 by the ISPOR Special Task Force aiming to spotlight elements of value that existing assessment frameworks may not routinely capture. However, formal methodological acknowledgement of the role novel value elements may play in HTA decision-making remains limited. This research aims to understand the extent to which NICE have begun to consider wider ‘uncaptured benefits’ and the potential impact on recommendations for new therapies.
METHODS: A literature review was conducted to identify NICE recommendations since the publication of the ISPOR ‘Value Flower’ in February 2018 until June 2025. Single technology appraisals (STAs) were screened to assess whether NICE considered the inclusion of broader value elements beyond those typically considered within the reference case during their decision-making.
RESULTS: The review identified 1,407 individual records, with 599 appraisals falling within the stated date range. After removing terminated, withdrawn, superseded and cost-comparison appraisals, 356 STAs remained. In this subset, NICE guidance explicitly indicated a meaningful presence of uncaptured benefits in 62 (17.4%) cases, the vast majority of which have been since 2022. Notably, 58 (93.5%) of these resulted in a positive recommendation, a proportion greater than the overall recommendation rate for NICE appraisals (84%).
The most common categories of uncaptured benefits cited include: impact on healthcare delivery and capacity, convenience and lifestyle impact, broader health-related quality of life considerations and alterations to the natural history of the disease which would have a downstream impact on how patients interacted with the healthcare system.
CONCLUSIONS: In recent years, NICE guidance has increasingly referred to the presence of uncaptured benefits that have directly influenced their decision-making. However, the broader value elements more often considered have limited overlap with the components in the ‘Value Flower’, suggesting more work is needed to link theoretical frameworks with the practical methodologies that drive decision-making.