OBJECTIVES: As global healthcare budgets become increasingly strained by rising drug costs, the role of cost-effectiveness (CE) watchdogs in providing timely guidance to healthcare decision makers is ever more important. Our research aims to evaluate the similarities and differences between the UK’s National Institute for Health and Care Excellence (NICE), and the USA’s Institute for Clinical and Economic Review (ICER).

METHODS: Data extraction, and a comparative analysis of ICER’s ‘A guide to ICER’s methods for HTA’ and NICE’s ‘Guide to the processes of technology appraisal’ focused on the following themes; topic selection / prioritization, evidence sources, CE analysis, financial thresholds, and conclusions.

RESULTS: Both bodies select Health Technology Assessment (HTA) topics based on input from independent advisory committees and public recommendations, using similar criteria to identify and prioritize topics. Although randomized controlled trials are considered ‘gold standard’ evidence, both will consider network meta-analysis where suitable, with ICER additionally leveraging patient group feedback to identify when real world evidence can be used. The predominant CE modelling method for both is cost-utility analysis, with CE thresholds at $50k-$150k/QALY (ICER) and £20k-£30k/QALY (NICE). Both evaluate net budget impact, with time horizons of five and three years for ICER and NICE respectively, with ICER’s annual threshold at $991M and NICE’s at £20M. ICER conclusions focus on the application of findings to policy and practice, including recommended actions for participating stakeholders, whereas NICE primarily focus on funding implications. Furthermore, whilst ICER publish discounts required to meet CE thresholds, such information remains confidential in NICE appraisals.

CONCLUSIONS: Whilst the frameworks and evidence supporting the CE evaluation demonstrate similarities across both bodies, key differences exist in financial thresholds, the framing of conclusions, and transparency of required actions to meet CE thresholds, which can be explained by ICER's independent consultative role, and NICE's public funding gatekeeper role.