Despite a well-established HTA process, NICE’s decision making is focused mainly on QALYs, only indirectly considering the impact of treatment related adverse effects (AEs) on patients. Whilst the effect of AEs on patients’ economic productivity and ability to go back to work after their illness is being explored in literature, little suggestions have been made on how to better capture these in NICE’s existing methods. The aim of this research is to review current approaches of including treatment related AEs, associated costs and disutilities in NICE appraisals.

NICE appraisals of seven cancer indications of nivolumab as immuno-oncology medicine were analysed and their AEs ranked and evaluated by severity, frequency, cost, disutility and overall impact on QALYs.

Economic models for the seven NICE appraisals included Grade 3/4 AEs occurring in ≥2 or ≥ 5% of patients. AEs most frequently reported were Anaemia (4x) followed by Diarrhoea and Dyspnoea ( both 3x). The Magnitude of utility decrements was consistent between indications, with neutropenia and thrombocytopenia having one the highest utility decrement of the indications considered. In general, AEs considered in the economic models have a small impact on the overall QALY decrement and ICER, due to the low frequency of Grade 3/4 AEs. Fatigue as one of the most common (but less severe) AEs in nivolumab patients is included in only two of the economic models.

Whilst the current QALY calculation approach allows for more severe AEs to be captured, it doesn’t capture less severe, but more frequent AEs with a potentially longer term impact on patients. New methods of calculating lost economic productivity due to treatment related AEs are needed in order to include productivity considerations in NICE HTA processes –across different disease areas in the future. These could be used alongside ICERs to consider broader economic benefits of new treatments.