OBJECTIVES: The National Institute for Health and Care Excellence (NICE) assesses the incremental clinical- and cost-effectiveness of healthcare technologies to inform public reimbursement recommendations in England and Wales. In 2022, NICE implemented a pilot for a new proportionate approach to technology appraisals, aiming to apply faster evaluation processes to simpler, low-risk treatments. This research assesses the impact of this approach on timing and outcomes of NICE recommendations.

METHODS: All NICE proportionate approach appraisals were identified (01-JAN-2022–17-JUL-2023) from https://www.nice.org.uk/. Parameters were then compared to NICE Single (STA) and Multiple Technology Appraisals (MTA) taking place in 2021/2022 (21-APR-2021–30-MAR-2022) from https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-technology-appraisal-guidance/data/appraisal-recommendations).

RESULTS: Five products have undergone NICE appraisals under the proportionate approach (somatrogon, vutrisiran, nintedanib, eptinezumab, and nivolumab), with four more currently being assessed. Four of the pharmaceutical products were recommended and one was optimised (restricted), with an average time between ‘invitation to participate’ and publication of 34 weeks (range: 22-40 weeks). In the 2021/2022 period, 104 NICE HTA recommendations for pharmaceutical products were identified. Overall, 71% of outcomes were positive (recommended, optimised, or approved via Cancer Drug Fund), 2% were only in research, 9% were not recommended, and 19% were non-submissions. The average appraisal time was 73 weeks (IQR: 50-90 weeks) for all recommended 2021/2022 appraisals.

CONCLUSIONS: Our analysis suggests that NICE’s proportionate approaches accelerate the assessment of products that meet the eligibility criteria by an average of 39 weeks. However, it is important to note that these pilot assessments were intended to test the viability of this approach and the products assessed are likely to have been carefully selected. It will be interesting to monitor outcomes from subsequent use of NICE’s proportional approaches to see the extent to which they are adopted more widely and to which they shorten assessments.