STRUCTURED EXPERT ELICITATION FOR LONG-TERM SURVIVAL ESTIMATES IN NICE APPRAISALS: A REVIEW OF EARLY EXPERIENCE FOLLOWING PUBLICATION OF TSD26
Author(s)
Elizabeth Thurgar, MSc, Guillem Hopmans Galofre, MSc, Ceri-Lune Renneboog, MPH, Janice Stricker-Shaver, PhD, Nathaniel Smith, PhD, James Horscroft, PhD.
Maple Health Group, New York, NY, USA.
Maple Health Group, New York, NY, USA.
OBJECTIVES: Technical Support Document 26 (TSD26), published in March 2025, provides recommendations on the use of expert elicitation for long-term survival outcomes. This research examined uptake of TSD26 recommendations in Single Technology Appraisal or Highly Specialised Technology submissions to the National Institute for Health and Care Excellence (NICE), and how analyses were received by evidence assessment groups (EAGs) and committees.
METHODS: We reviewed NICE technology appraisals published between March 2025 and May 2026 in which long-term survival was a key issue for committee discussion. Committee papers were reviewed to identify use of structured expert elicitation (SEE), whether recommendations in TSD26 were considered, and EAG or committee feedback. TACRAWLR was used to supplement searches to ensure no relevant appraisals were missed.
RESULTS: A total of 119 appraisals were identified, of which 86 were included in the review (exclusions: terminated appraisals, n=30; cost-comparison, n=3). Of the 86 appraisals, 47 included long-term survival as a key issue for discussion. SEE to inform long-term survival was reported in four appraisals (8.5%) with one, TA1153, referencing TSD26 directly. Approaches included SHELF (n=1), Delphi (n=1), "modified" SEE (n=1) and SEE with no specific method described (n=1). Detailed discussion of elicitation methods by EAGs or committees was limited; however, one EAG raised concerns regarding small numbers of experts and uncertainty associated with elicited estimates. Committees for TA1049 and TA1147 noted the absence of SEE as a weakness.
CONCLUSIONS: Uncertainty around long-term survival is a common issue for NICE committees. Despite this, only a small proportion of manufacturer submissions (4/47) included SEE to support survival assumptions. Discussion of elicitation methods by EAGs and committees was generally limited; however, there was some evidence that committees viewed SEE as a means of addressing evidence gaps, suggesting that expectations regarding its application and reporting may be evolving.
METHODS: We reviewed NICE technology appraisals published between March 2025 and May 2026 in which long-term survival was a key issue for committee discussion. Committee papers were reviewed to identify use of structured expert elicitation (SEE), whether recommendations in TSD26 were considered, and EAG or committee feedback. TACRAWLR was used to supplement searches to ensure no relevant appraisals were missed.
RESULTS: A total of 119 appraisals were identified, of which 86 were included in the review (exclusions: terminated appraisals, n=30; cost-comparison, n=3). Of the 86 appraisals, 47 included long-term survival as a key issue for discussion. SEE to inform long-term survival was reported in four appraisals (8.5%) with one, TA1153, referencing TSD26 directly. Approaches included SHELF (n=1), Delphi (n=1), "modified" SEE (n=1) and SEE with no specific method described (n=1). Detailed discussion of elicitation methods by EAGs or committees was limited; however, one EAG raised concerns regarding small numbers of experts and uncertainty associated with elicited estimates. Committees for TA1049 and TA1147 noted the absence of SEE as a weakness.
CONCLUSIONS: Uncertainty around long-term survival is a common issue for NICE committees. Despite this, only a small proportion of manufacturer submissions (4/47) included SEE to support survival assumptions. Discussion of elicitation methods by EAGs and committees was generally limited; however, there was some evidence that committees viewed SEE as a means of addressing evidence gaps, suggesting that expectations regarding its application and reporting may be evolving.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA270
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Topic Subcategory
Decision & Deliberative Processes
Disease
Oncology