OBJECTIVES

The National Institute for Health and Care Excellence (NICE) makes recommendations on the public reimbursement of medicines based on their clinical- and cost-effectiveness. The recommendation is made by an Appraisal Committee (comprising a multi-disciplinary group of independent experts) as part of a technology appraisal. There are four Appraisal Committees (A, B, C, D); previous research indicated that single technology appraisals (STA) undertaken by NICE Appraisal Committee D were associated with a significantly lower rate of 'recommended' outcomes than other committees (Macaulay et al., ISPOR EU 2017). This research aims to evaluate whether this can be accounted for by differences in implementation of End of Life (EoL) criteria.

METHODS

NICE STA guidance for oncology drugs was screened (18/06/2009-20/03/2019) and EoL consideration data extracted alongside the Appraisal Committee.

RESULTS

205 STA-recommendations for oncology drugs were identified (41% recommended, 18% optimized, 9% recommended for the Cancer Drugs Fund, and 20% not recommended). EoL criteria were discussed in 56% (115/205) of appraisals and were deemed to apply in 63% of cases (72/115, 94% of which were recommended, optimized or recommended for the Cancer Drugs Fund). Where EoL criteria were considered, they were deemed to apply in 71% (15/21), 59% (13/22), 63% (20/32), and 57% (17/30) of STAs by Appraisal Committees A, B, C, and D, respectively. There was no significant difference in acceptance of EoL criteria by committee (X2/3=4.5, p=0.21).

CONCLUSIONS

Differential implementation of EoL criteria does not account for STAs undertaken by NICE Appraisal Committee D being associated with a significantly lower rate of 'recommended' outcomes than the other committees. Further research is needed to determine if there are other confounding factors (such as the types of drugs appraised) or whether this may reflect deviation in uniform implementation of NICE methodology between Committees.