Presentation (CTI)

OBJECTIVES: Assessments of innovative technologies by NICE often reveal uncertainties in how delivery of the service will work in practice. NICE includes service delivery costs and resource use in its health technology assessment (HTA). This leads to service delivery uncertainties (SDUs) impacting committee decision making. This research identified the number of HTAs with a specified SDU and categorised SDUs by theme.
METHODS: SDUs were extracted from HTAs that followed NICE STA2022 methods between 2022 and 2026. SDU was defined as any evidence that informed how a medicine would be delivered in clinical practice but was deemed uncertain. All uncertainties extracted were identified during the HTA process. Description of SDU, number of HTAs with SDUs, and number of SDUs per HTA were extracted. Thematic analysis was conducted to assess common themes of uncertainty among HTAs. By consulting with the national payer, SDUs were placed on a spectrum based on data collection difficulty.
RESULTS: 119 out of 293 (41%) HTAs cited at least 1 SDU (range 1 - 5). Non-cancer HTAs were significantly more likely to have a SDU than cancer HTAs (p=0.03). 94 (79%) HTAs with an SDU had uncertainties related to cost; 60 (50%) related to administration and care; 21 (15%) related to diagnosis and measurement; and 7 (6%) related to population characterisation. Uncertainty specificity ranged from whole service uncertainty to specific data items on resourcing and diagnostic test inclusion. On the SDU spectrum, data on population characterisation was considered easiest to collect and data on non-medical costs the most difficult.
CONCLUSIONS: The ability to categorise and deepen understanding of SDUs is increasingly important to support payers and providers in implementing NICE HTA guidance for innovative medicines. We now have a framework to improve estimates of service delivery evidence for HTA and to assess whether collecting data on these uncertainties is a viable prospect.