INCLUDING CARER HRQOL IN NICE STAS: ADVANCING BROADER VALUE EVIDENCE GENERATION
Author(s)
Claire Sloan, MSc1, Catrin Treharne, BSc, MSc2, Robert King, BSc, MSc1.
1LCP Health, London, United Kingdom, 2LCP Health, LONDON, United Kingdom.
1LCP Health, London, United Kingdom, 2LCP Health, LONDON, United Kingdom.
OBJECTIVES: NICE recognises carer burden, yet inclusion of carer health-related quality of life (HRQoL) in single technology appraisals (STAs) remains inconsistent. This study assessed how carer health-related quality of life (HRQoL) has been incorporated in NICE single technology appraisals (STAs), and examined the evidence sources, modelling assumptions, and consequences of alternative carer HRQoL inputs using multiple sclerosis (MS) as a case study.
METHODS: We conducted a targeted review of published studies reporting inclusion of carer HRQoL in NICE appraisals across therapy areas. We examined MS as a case study in light of an identified precedent for incorporating carer HRQoL. We reviewed NICE MS appraisals published between 2000 and 2026 and extracted carer HRQoL evidence sources, committee discussions, and the impact of alternative inputs on cost-effectiveness results.
RESULTS: Published literature suggests that inclusion of carer HRQoL in NICE appraisals is infrequent and inconsistent across therapy areas. In MS, early appraisals predominantly used Alzheimer’s disease proxy values for carer HRQoL. MS-specific estimates published in 2013 were adopted in several appraisals between 2017 and 2019, but from 2021 some appraisals reverted to proxy estimates or presented both sources. Committee discussions highlighted uncertainty regarding the transferability and face validity of proxy evidence. The choice of data source had the potential to materially affect the incremental cost-effectiveness ratio (ICER), with one appraisal (TA656) reporting that applying MS-specific estimates resulted in a 31% increase in the ICER compared to the use of proxy values.
CONCLUSIONS: Carer HRQoL remains underused in NICE STAs and, when included, often relies on proxy evidence from other conditions. The MS case study shows that dependence on proxy data can persist even when condition-relevant evidence exists, creating inconsistency and decision uncertainty. Generating condition-specific carer HRQoL evidence prospectively may improve consistency, reduce decision uncertainty, and support more robust consideration of broader value in health technology assessment.
METHODS: We conducted a targeted review of published studies reporting inclusion of carer HRQoL in NICE appraisals across therapy areas. We examined MS as a case study in light of an identified precedent for incorporating carer HRQoL. We reviewed NICE MS appraisals published between 2000 and 2026 and extracted carer HRQoL evidence sources, committee discussions, and the impact of alternative inputs on cost-effectiveness results.
RESULTS: Published literature suggests that inclusion of carer HRQoL in NICE appraisals is infrequent and inconsistent across therapy areas. In MS, early appraisals predominantly used Alzheimer’s disease proxy values for carer HRQoL. MS-specific estimates published in 2013 were adopted in several appraisals between 2017 and 2019, but from 2021 some appraisals reverted to proxy estimates or presented both sources. Committee discussions highlighted uncertainty regarding the transferability and face validity of proxy evidence. The choice of data source had the potential to materially affect the incremental cost-effectiveness ratio (ICER), with one appraisal (TA656) reporting that applying MS-specific estimates resulted in a 31% increase in the ICER compared to the use of proxy values.
CONCLUSIONS: Carer HRQoL remains underused in NICE STAs and, when included, often relies on proxy evidence from other conditions. The MS case study shows that dependence on proxy data can persist even when condition-relevant evidence exists, creating inconsistency and decision uncertainty. Generating condition-specific carer HRQoL evidence prospectively may improve consistency, reduce decision uncertainty, and support more robust consideration of broader value in health technology assessment.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA12
Topic
Economic Evaluation, Health Technology Assessment, Patient-Centered Research
Topic Subcategory
Decision & Deliberative Processes
Disease
Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas