REVIEW OF NICE SUBMISSIONS AND COMPARISON OF ECONOMIC MODEL STRUCTURES AND METHODOLOGICAL PRECEDENT IN RETINAL DISEASES
Author(s)
Laure Weijers, PGCert1, Chris Bojke, BA, MSc, PhD2, Karl Patterson, PhD3, Hannah Baker, MSc4, Grant McCarthy, MSc4.
1Lumanity, Utrecht, Netherlands, 2Lumanity, Leeds, United Kingdom, 3Lumanity, London, United Kingdom, 4MSD UK, London, United Kingdom.
1Lumanity, Utrecht, Netherlands, 2Lumanity, Leeds, United Kingdom, 3Lumanity, London, United Kingdom, 4MSD UK, London, United Kingdom.
OBJECTIVES: This study reviewed National Institute for Health and Care Excellence (NICE) health technology assessment (HTA) appraisals to facilitate a comparison of economic model structures and methodological precedent across diabetic macular oedema (DMO), neovascular age-related macular degeneration (nAMD) and retinal vein occlusion (RVO). The objective was to guide future cross-indication model development and identify opportunities for methodological standardisation.
METHODS: A targeted review of 16 NICE appraisals in retinal diseases (6 DMO, 5 nAMD and 5 RVO), published between 2011 and 2024, was conducted. Key methodological characteristics were extracted alongside supporting rationale where provided. Critiques and methodological issues raised by the Evidence Assessment/Review groups and NICE Committee were also analysed.
RESULTS: Of the 17 models identified (one appraisal featured two models), 10 were cost-utility analyses with the remainder being cost-comparisons. Across all indications, Markov state-transition structures were most common. In cost-utility analyses, VA-based health states were frequently defined using Early Treatment Diabetic Retinopathy study (ETDRS) letters, however, the number and thresholds of categories varied. Approach to applying utilities was variable both within indications and across indications, although this has not been a recent area of focus due to the trend toward cost-comparison approaches. Excess mortality was applied to account for either comorbidity (e.g. diabetes) or vision loss, or both. Across indications, there appears to be no consistent view of how long treatment lasts or effects persist, despite broadly similar anti VEGF paradigms, introducing uncertainty to both costs and effects.
CONCLUSIONS: Retinal diseases represent a relatively mature HTA area, and overall modelling approaches were broadly consistent across indications, reflecting established precedent. However, variability persists at a more granular level, with differences observed in the specification of VA health states, utility modelling, and treatment duration assumptions, often with limited justification. Greater standardisation of these elements may improve model transparency and reduce uncertainty in decision-making.
METHODS: A targeted review of 16 NICE appraisals in retinal diseases (6 DMO, 5 nAMD and 5 RVO), published between 2011 and 2024, was conducted. Key methodological characteristics were extracted alongside supporting rationale where provided. Critiques and methodological issues raised by the Evidence Assessment/Review groups and NICE Committee were also analysed.
RESULTS: Of the 17 models identified (one appraisal featured two models), 10 were cost-utility analyses with the remainder being cost-comparisons. Across all indications, Markov state-transition structures were most common. In cost-utility analyses, VA-based health states were frequently defined using Early Treatment Diabetic Retinopathy study (ETDRS) letters, however, the number and thresholds of categories varied. Approach to applying utilities was variable both within indications and across indications, although this has not been a recent area of focus due to the trend toward cost-comparison approaches. Excess mortality was applied to account for either comorbidity (e.g. diabetes) or vision loss, or both. Across indications, there appears to be no consistent view of how long treatment lasts or effects persist, despite broadly similar anti VEGF paradigms, introducing uncertainty to both costs and effects.
CONCLUSIONS: Retinal diseases represent a relatively mature HTA area, and overall modelling approaches were broadly consistent across indications, reflecting established precedent. However, variability persists at a more granular level, with differences observed in the specification of VA health states, utility modelling, and treatment duration assumptions, often with limited justification. Greater standardisation of these elements may improve model transparency and reduce uncertainty in decision-making.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE734
Topic
Economic Evaluation, Health Technology Assessment
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Sensory System Disorders (Ear, Eye, Dental, Skin)